MEDICAL TEXT-BOOKS 



PUBLISHED BY 



LINDSAY & BLAKISTON, PHILADELPHIA. 



Roberts's Handbook of the Practice of Medicine. Uniformly 
commended by the profession and the press. Octavo. Price, 
bound in cloth, $5.00; leather, $6.00. 

Trousseau's Clinical Medicine. Complete in two volumes, octavo. 
Price,»in doth. ftlO.00: leather. $12 00. 

AitKcn s i ■ T -w-r-k *^ . -^ •--— ,& d American 

from ti I LIBRARY OF CONGRESS, i^ octavo. 

Price ' t . "rtv — — i 

Sanaersor f /f,„„ ' iv A ' ?. ' Vf Oratory. Ex- 
ercises |f ha P f W'SW Jo. 1 363 ^ HStra . 

ti0nS - t JMe// _£jft I* 7 ' 00 ' 

Cazeaax's J " @ Illustrated. 

Cloth, | UNITED STATES OF AMERICA. I 

Waring's B*******,*,*^*^,^^^^ London Edi- 

Rindfleisch's Pathological Histology. Containing 208 elabo- 
rately executed Microscopical Illustrations. Cloth, $6.00 ; leather, 
$7.00. 

Meigs and Pepper's Practical Treatise on the Diseases of 
Children. Fifth Edition. Cloth, $6.00 ; leather, $7.00. 

Tanner's Practice of Medicine. Sixth American Edition. Cloth, 
$6.00; leather, $7.00. 

Tanner and Meadow's Diseases of Infancy and Childhood. 

Third Edition. Cloth, $3.00. 

Biddle's Materia Medica for Students. Seventh Eevised Edi- 
tion. With Illustrations. Price, $4.00. 

Harris's Principles and Practice of Dentistry. Tenth Eevised 
Edition. Cloth, $6.50; leather, $7.50. 

Paget's Surgical Pathology. By Turner. Third London Edi- 
tion. Price, $7.50. 



Soelberg Wells on Diseases of the Eye. Third London Edition. 
Cloth, $5.00; leather, $6.00. 

Byford's Practice of Medicine and Surgery. Applied to the 
Diseases of Women. Second Edition. Cloth, $5.00; leather, 
$6.00. 

Byford on the Uterus. A new Enlarged Edition. Illustrated. 
Price, $3.00. 

Hewitt's Diagnosis and Treatment of the Diseases of Women. 

Third Edition. Cloth, $5.00; leather, $6.00. 

Headland on the Action of Medicines. Sixth American Edi- 
tion. Price, $3.00. 

Beale's How to Work with the Microscope. Fifth Edition. 
400 Illustrations. Preparing. 

Harley on Urine and its Derangements. With Illustrations. 
Price, $2.75. 

Meadow's Manual of Midwifery. Third Enlarged Edition. 

Bloxom's Chemistry. Inorganic and Organic. Second Edition. 
276 Illustrations. Cloth, $4.50; leather, $5.50. 

Walton's Practical Treatise on Diseases of the Eye. Second 
Edition. Numerous Illustrations, Test-Types, etc. Price, $9.00. 

Jones and Sieveking's Pathological Anatomy. A New En- 
larged Edition, edited by J. F. Payne, M.D. Price, $6.00. 

Wilks and Moxon's Pathological Anatomy. Second Edition, 
Enlarged. Price, $6.50. 

Carpenter's Microscope and its Revelations. Fifth Edition. 
500 Illustrations. Price, $5.50. 

Wilson's Anatomists' Vade Mecum. Ninth Enlarged London 
Edition. Price, $5.50. 

Druitt's Surgeon's Vade Mecum. Tenth Enlarged London Edi- 
tion. Price, $5.00. 

Parke's Manual of Practical Hygiene. Fourth Enlarged Edi- 
tion. Price, $6.00. 

Tomes's System of Dental Surgery. Second Enlarged Edition. 
Price, $5.00. 

Richardson's Mechanical Dentistry. Second Edition, much En- 
larged. Price, $4.50. 

Beale's Use of the Microscope in Practical Medicine. Fourth 
Edition. 500 Illustrations. Preparing. 



COHEN 



INHALATION 



COHEN ON CROUP. 

Croup, in its Relations to Tracheotomy. Based on a care- 
ful study of the published records of more than five thousand 
cases of Tracheotomy in Croup, performed in various portions 
of the world. By J. Solis Cohen, M.D., Lecturer on Laryn- 
goscopy and Diseases of the Throat and Chest in Jefferson Medi- 
cal College. Keprinted from the " Transactions of the Medical 
Society of Pennsylvania." Octavo. Price, $1.00. 

" ' "Would that more such books were published,' was our sincere 
wish on finishing the attentive perusal, we may say study, of the 
work, the title of which heads this article. It is a book of only 
seventy-eight pages, and what most people call not an original 
book ; yet, in our deliberate judgment, the whole medical profes- 
sion owe Dr. Cohen a debt of gratitude for it which can only be 
paid by each member doing his part toward making it known to 
every other member. It contains a conscientious compilation and 
judicious appreciation of all that could be gathered by the author 
upon the subject of which it treats ; and, so far as knowledge of a 
practical subject can be acquired by reading, whoever chooses to 
make these comparatively few pages his own will become thoroughly 
posted." — New York Medical Record. 

"Viewed as a whole this brochure contains much that every 
practical surgeon should know, and gives a full exhibition of the 
present position of this remedial measure, and its author is entitled 
to the thanks of the profession for the good work he has done." — 
The American Journal of Medical Sciences, April, 1875. 



OTHER ESSAYS BY DR. COHEN. 

A Brief Exposition of the Management of the Laryngo- 
scope. Illustrated ; 8vo., pp. 19. 1871. 
Fetid Coryza. 12mo. ; pp. 16. Philadelphia, 1874. 
Sore Throat. 8vo. ; pp. 11. Philadelphia, 1874. 



INHALATION 



IN THE TREATMENT OF DISEASE 



ITS THERAPEUTICS AND PRACTICE. 



A TREATISE 



INHALATION OF GASES, VAPORS, FUMES, COMPRESSED AND 
RAREFIED AIR, NEBULIZED FLUIDS, AND POWDERS. 



J. SOLIS COHEN, M.D., 

LECTURER ON LARYNGOSCOPY AND DISEASES OF THE THROAT AND CHEST, IN 

JEFFERSON MEDICAL COLLEGE; ONE OF THE PHYSICIANS TO THE 

GERMAN HOSPITAL OF PHILADELPHIA ; EX-PRESIDENT 

OF THE NORTHERN MEDICAL ASSOCIATION 

OF PHILADELPHIA, ETC., ETC. 



SECOND EDITION, REVISED AND ENLARGED, WITH 
MA N Y NE WILL US TR A TIONS. 



'k 



* 



V 

PHILADELPHIA: 

LINDSAY & BLAKISTOK 

18 7 6. 






Entered according to Act of Congress, in the year 1876, 

By LINDSAY & BLAKISTON, 

In the office of the Librarian of Congress, at Washington. 



PHILADELPHIA : 
SHERMAN & CO., PRINTERS. 



PREFACE TO THE SECOND EDITION. 



The author's treatise on Inhalation having been some 
time out of print, and a new edition called for, the text 
has been subjected to revision, and such additions and 
alterations have been made as seemed requisite to pre- 
sent the subject from the standpoint of the day. It has 
not been deemed advisable to add to the number of cases 
recorded in the first edition, as this would have incum- 
bered the volume without serving any adequate purpose; 
indeed, a number of cases, previously recorded, are 
omitted in the present edition as superfluous. 

The article on Compressed and Rarefied Air has been 
much enlarged, to render it commensurate with the 
amount of attention bestowed on pneumatic therapeutics, 
abroad, in the treatment of certain affections of the lungs 
and heart. 

Additional illustrations have been introduced where 
they have been thought likely to add to the value of the 
work. For several of these we are gratefully indebted 
to Codman & Shurtleff, of Boston, Tiemann & Co. and 
J. Reynders & Co., of New York, and Gemrig, of 
Philadelphia. 

1431 Walnut Street, 
Philadelphia, January, 1876. 



PREFACE TO THE FIRST EDITION. 



Inhalation, especially by the method of nebuliza- 
tion, is at present attracting favorable attention from 
the profession. 

At the annual meeting of the American Medical As- 
sociation, held in Baltimore, in 1866, a committee, of 
which the writer was chairman, was appointed to pre- 
pare for the meeting of 1867 a report on the Therapeu- 
tics of Inhalation. In the preparation of this report, 
the writer accumulated a quantity of material much too 
voluminous for that purpose, and determined to incor- 
porate the most valuable portions in book-form, present- 
ing in some detail the historical record of experiments, 
pathological studies, etc., from which conclusions were 
drawn for the report. The principal literature on the 
subject is foreign — for the most part German — the most 
elaborate work being (Die Inhalations- Therapie) by Dr. 
George Lewin, of Berlin, from which much has been 
drawn in the preparation of the present volume, besides 
which, as will be seen, many other authors have been 
consulted, as also an extensive file of foreign and Ameri- 
can journals; while the private experience of several 
practitioners in this country has been laid under con- 
tribution. 

Philadelphia, October 1st, 1867. 



INTEODUCTION. 



In examining the literature upon our subject, we find 
that from the earliest ages inhalation has been employed 
in Greece, in Rome, in Arabia, and thence, with the 
extension of medical knowledge, everywhere. Again 
and again has the method been extensively resorted to, 
and subsequently fallen into disuse, perhaps into abuse, 
for at each resumption it has seemed necessary to ad- 
vance specious reasons to account for its previous neglect. 

From time to time fresh discoveries in pneumatics 
have given renewed impulse to further investigation of 
the subject; and at each period with some permanent 
beneficial result. 

Thus the discovery of oxygen by Priestley and Scheele 
in the middle of the last century, led to experiments 
upon the economy with " different kinds of air ;" and 
atmospheres noxious and innocuous became pressed into 
the service of therapeutics. 

Then, early in the present century, the discovery of 
the peculiar properties of chlorine and iodine, led anew 
to examination of the physical properties of volatile sub- 
stances ; and the inhalations of resinous materials, of 
narcotics, etc., were again brought into medical requi- 
sition. 

Again, the observed effects of compressed air in cer- 



Vlll INTRODUCTION. 

tain of the mechanical employments, attracted experi- 
ment as to its value as a therapeutic agent. 

Finally, the more recent device of a method of subdi- 
viding a liquid into a spray-cloud or nebula, and thus 
utilizing it in this attenuated form to the purposes of 
inhalation, and enlarging at once its sphere of useful- 
ness, gave a fresh impetus to the study of the Therapeu- 
tics of Inhalation, which has resulted in the acquisition 
of new and valuable methods for at least affording grate- 
ful relief in certain pulmonary affections, to the cure of 
which medicine is, unfortunately, inadequate. 

The personal attention necessary to insure proper in- 
halation, even of the most volatile substances, has no 
doubt debarred many physicians from a resort to the 
method, in preference to the much easier plan of advis- 
ing a patient to swallow a draught or a pill ; and this, 
perhaps, is the reason why it has so long been found 
principally in use by a class of practitioners, " who," to 
use the language of the author of one of our best works 
on Therapeutics, " inhabit the debatable region between 
medicine and quackery.' 7 Dr. Rogers, in a note to 
Elliotson's Practice, Philadelphia Edition, 1844, p. 804, 
says: "A medical man, when he orders a patient to in- 
hale vapors, must give his personal attention to the 
manner in which it is performed, if he wishes to have his 
intentions efficiently carried out. On one occasion, in 
a large hospital, when a patient with ulcerated sore 
throat had been ordered to inhale steam, I found him 
with a tin inhaler comfortably tucked under the bed- 
clothes with a cork stuffed into the air-tube. The con- 
sequence of this was that the patient was obliged to 
remove his mouth from the instrument after every in- 
spiration, and after all his laborious efforts the supply of 



INTRODUCTION. IX 

steam was very inefficient. The nurse (in every respect 
an excellent one), on being questioned as to the use of 
the cork, very naturally replied that it was ' to keep in 
the steam ;' and added, that she had been in the hospital 
eleven years and never saw an inhaler used in any other 
way. There is nothing surprising in all this. Xurses 
are not expected to understand the principles of pneu- 
matics. On instituting an inspection of the other in- 
halers in the hospital, every one of them was found duly 
provided with a cork/' 

The material collected in the following pages will 
show that inhalation has at all times possessed the con- 
fidence of men in good professional repute. Our various 
works on Therapeutics and Materia Medica, Copland's 
Dictionary, and the works on Practice issued in the ear- 
lier portion of the present century, give historical lists, 
more or less complete, of the various authorities who 
have at times employed inhalations and recommended 
them, as well as lists of the remedies resorted to. To 
have presented a complete list in the present volume 
would have occupied many -pages that are devoted to 
matter more practical, and the writer has been unwilling 
to furnish an incomplete record. Instead of an extended 
display of authorities, therefore, reference is made in 
each appropriate place to those individuals to whom the 
profession is indebted for having first prominently 
placed before them the merits of the inhalations of va- 
rious remedies in certain diseases ; and with regard to 
the new method of inhaling nebulized fluids, the au- 
thorities cited are, as far as possible, authenticated, and 
credit given to the sources from which information has 
been derived. 

The subject is still incomplete ; the observations re- 



X INTRODUCTION. 

corded at various times are not yet sufficiently numerous, 
accurate, or corroborative of each other for the deduc- 
tion of positive conclusions ; and it is to be regretted 
that the value of a faithful record of unfavorable results 
has not attracted a sufficient share of attention from 
those who have hitherto written on the subject. 

Such observations and records of authors, abroad and 
at home, as have seemed to the writer most valuable 
from the mass of matter which has accumulated on his 
hands, are laid before the reader that he may form his 
own estimate of their value. The writer has endeavored 
to present the subject as impartially as a decided bias in 
favor of inhalations would permit. 

It may not be amiss here to answer an objection that 
will often be heard urged against inhalation. It is this : 
Inhalation being defended on the ground that affected 
structures are thus subjected to local treatment ; and, at 
the same time, it being impossible to limit the local 
action to the diseased structures ; where, then, the great 
benefit? We see, however, that the objection holds 
good in a measure, with regard to medicines given by 
the stomach ; they affect more or less the entire system, 
though their action may predominate in some one direc- 
tion ; but there is a class of therapeutists who teach that 
it is by sustaining those portions of organs still healthy, 
and protecting them against the extension of morbific 
processes, which have already imperilled the integrity 
of part of their substance, or at any rate temporarily 
impaired their natural functions, that we are able to ex- 
tend the restorative influence by continuance of molecu- 
lar action into the very structures diseased, and thus 
excite them, as far as they are not disorganized or 
changed, to a return of normal function. Healthy tis- 



INTRODUCTION. XI 

sues, too, resist the effect of medicines, local or general ; 
thus we can rarely restrict the action of a lotion or a 
caustic to the diseased structures, and the parts in imme- 
diate contiguity often receive a full benefit from the ap- 
plication; still, they recover from it, so that even an 
accidental occurrence of the kind affords no valid argu- 
ment against the use of such local treatment. 

It seems plausible, too, that even when remedies act 
systemically, we should anticipate better results by im- 
pressing first the particular organs designed to be acted 
upon with any remedy by its passage through the sys- 
tem, than by impressing the system primarily and the 
affected organ secondarily, by the passage through it of 
medicated blood-plasma, or modified nerve-force; be- 
sides which, the systemic exhalants are more actively 
called upon for their emunctorial duties than are the 
systemic absorbents for the impression of some special 
organ ; added to which, the changes which may occur 
during the progress of the digestion of a medicine may 
alter its primary effect ; and if any difference has been 
detected in the effect of any remedy as administered by 
inhalation or deglutition, it is not illogical to trace the 
cause, in a great measure, to the digestive process to 
which it is subjected in the stomach, where the remedies 
undergo preparation for absorption. We administer 
remedies for the production of effects known to occur 
after exposure to the digestive process, and it may be 
possible that their action would be different were they 
not thus digested ; at any rate, we act upon such prem- 
ises, for we diminish the quantity of medicine to be in- 
troduced by direct absorption into the body for a certain 
effect, whether by the skin or by the bronchial mucous 
membrane ; and therefore, in resorting to inhalatory 



Xll INTRODUCTION. 

therapeutics, we must carefully watch the effect of reme- 
dies; for much judgment may be required in the selec- 
tion of a special materia medica. One advantage is, 
that remedies exhibited for inhalation are usually pre- 
sented in a simply medicinal form, deprived in great 
measure of the original (resinous, woody, or other) con- 
necting medium, which is more apt to be preserved as 
usually administered ; and another is that the misfor- 
tunes and errors of the elaborate prescriptions of poly- 
pharmacists are less apt to be endured by the patient. 

As has again and again been proven by actual experi- 
ment on the lower animals, and on man, the mucous 
membrane of the respiratory organs has a much greater 
capacity for absorption than that of the stomach, than 
which it is much more delicate; and for articles not de- 
sirable to be exposed to the solvent principle of the gas- 
tric juice, inhalation is at least as advantageous a mode, 
in many instances, for the administration of appropriate 
remedies, as the skin or connective tissue. The mate- 
rial inhaled comes directly in close juxtaposition to the 
blood while in its most vital state, and is thus more 
promptly and more thoroughly absorbed into the tide of 
the circulation than when it traverses part of the venous 
circuit before exposure to the inspiratory effort. It is 
often advantageous, too, that nothing shall interfere di- 
rectly with the digestive functions. 

The promptness with which the respiratory mucous 
membrane absorbs is well shown in the action of gen- 
eral anaesthetics, and he who is skeptical as regards the 
facility with which other articles of the materia medica 
are absorbed, can perform upon himself the experiment 
of taking a certain amount of a narcotic by the stomach, 
and at another time, under similar conditions of body as 



INTRODUCTION. Xlll 

well as may be, inhaling a similar amount of the same 
narcotic in solution, by some of the methods described 
in the pages of this volume ; and, unless he be the sub- 
ject of some idiosyncrasy, the truth of the matter may 
safely rest upon his own verdict as to the resulting 
sensations. 



TABLE OF CONTENTS. 



PAGE 

Preface to the Second Edition, v 

Preface to the First Edition, vi 

Introduction, vii 

Table of Contents, xv 

List of Illustrations, xix 

PART I. 

The Inhalation of Airs, Gases, Vapors, and Eumes, . 13 
Inhalers, . . . . . . . . . . .19 

Atmospheric Air, 33 

Condensed and Rarefied Air, ....... 37 

Oxygen, 61 

Ozone, 79 

Nitrous Oxide, 80 

Nitrous Acid, 81 

Hydrogen, 82 

Sulphuretted Hydrogen, ....... 83 

Carbonic Acid, 83 

Carburetted Hydrogen, 87 

Chlorine, 91 

Iodine, 96 

Iodoform, 110 

Bromine, .......... 110 

Sulphur, Ill 

Ammonium, .......... 113 

Chloride of Ammonium, . . . ... . . 115 

Chloroform, .......... 118 

Ether, 121 

Nitrite of Amyl, 131 

Balsamic Vapors, ......... 133 

Resinous Vapors of the Coniferae, 136 



XVI 



CONTENTS, 



Tar, 

Oil of Turpentine, . 

Oils of Pine, . 

Other Essential Oils, 

Oxygenated Essences 

Creasote, 

Carbolic Acid, 

Opium and other Narcot 

Nitrate of Potassium, 

Camphor, 

Lime, 

Arsenic, . 

Mercury, 

Chloride of Copper 

Hot Water, . 



PART II 



PAGE 
139 

144 
148 
150 
151 
151 
154 
156 
163 
164 
166 
170 
172 
176 
177 



Inhalation of Nebulized Fluids, or Sprays, . . 184 
Nebulized Medicaments and the Apparatus for their Pro- 
duction, 184 

Experiments upon Men and Animals as to the Penetration 

of Nebulized Fluids into the Respiratory Passages, . . 213 

Experiments with Negative Results, ..... 214 

Experiments with Positive Kesults, 224 

Keport on the foregoing Experiments to the Parisian Acad- 
emy of Medicine, 230 

Further Experiments in Germany and elsewhere, . . . 233 

Pathological Proofs of Penetration, 239 

The Inhalation of Nebulized Fluids, 246 

The Proportion of Nebula Inhaled, . . . • . .247 

Immediate Effects of the Inhalation of Nebulized Fluids, . 250 

Manner of Conducting the Inhalation of Nebulized Fluids, . 251 

Number, Strength, and Duration of Inhalations, etc., . . 257 

Articles of the Materia Medica suitable for Nebulization, . 259 

Summary, .......... 334 

PART III. 

The Inhalation of Powders, 336 

The Insufflation or Inhalation of Powders in Affections of 

the Eespiratory Organs, ....... 336 



CONTENTS. XV11 

PAGE 

Experiments on Men and Animals proving the Penetration 
of Powders into the Respiratory Tracts, .... 345 

Pathological Proofs of the Penetration of Powders into the 
Lung Tissue, 350 

Articles of the Materia Medica employed by Inhalation or 
Insufflation in Powder, ....... 363 



PART IV. 

Medicated Atmospheres, 370 

Index, 381 



LIST OF ILLUSTRATIONS. 



FIG. page 

1. Mudge's Inhaler (from Mudge), . . . . . 20 

2. Wolfe-Bottle Inhaler. 21 

3. Simple modification of Wolfe-Bottle Inhaler, . . 21 

4. Beigel's Mouth-Piece (from Beigel), .... 22 

5. Mackenzie's Eclectic Inhaler (from Mackenzie), . . 24 

6. Mandl's Inhaler or Funiigator (from Mandl), . . 26 

7. Bumstead's Calomel Vaporizer (J. Reynders & Co.), . 29 

8. Pomeroy's Inhaler (G-emrig), 30 

9. Lewin's Apparatus for the Inhalation of Nascent Vapors 

of Sal Ammoniac (from Lewin), .... 32 

10. Dobell's Besidual Air-Pump (G. Tiemann & Co.), . 44 

11. Waldenburg's Apparatus for Inhalation of Condensed 

and Karefied Air (Gemrig), 45 

12. Biedert's Apparatus for Inhalation of Condensed and 

Rarefied Air (J. Reynders & Co.), .... 49 

13. Frankel's Apparatus for Inhaling Condensed and Rare- 

fied Air (J. Reynders & Co.), 52 

14. Stoerck's Apparatus for Inhalation of Condensed and 

Rarefied Air (from Stoerck), 56 

15. Porter's Croup-Kettle (J. Reynders & Co.), . . . 182 

16. Sales-Girons's Pulverisateur Portatif (from Lewin), . 186 

17. Mathieu's Nephogene (from Lewin), .... 189 

18. Mathieu's Nebulizer (from Mathieu), .... 193 

19. Lewin's Glass Nebulizer (from Lewin), . . . 195 

20. The Bergson Tubes, 197 

21. Bergson's Apparatus with the Foot-Bellows (from 

Lewin), 198 



XX LIST OF ILLUSTRATIONS. 

FIG. PAGE 

22. (Modification of) Clarke's Nebulizer (Codman & Shurt- 

leff), ... 199 

23. Dr. Sass's Horizontal Nebulizer, with Tubular Reser- 

voir (G. Tieraann & Co.), 202 

24. Bergson's Tubes reversed, with the Reservoir on top, . 205 

25. Siegle's Steam Nebulizer, 208 

26. Codman & Shurtleff's Steam Nebulizer (Codman & 

Shurtleff), 209 

27. Modified Form of Siegle's Steam Nebulizer, with Duck- 

bill Tubes, 210 

28. Rauchfuss's Insufflator (Codman & Shurtleff), . . 341 

29. Oro-nasal Respirator (Tiemann & Co.), .... 376 



ON INHALATION. 



PAET I. 



THE INHALATION OF AIES, GASES, VAPORS, AND 

FUMES. 

The utilization of the normal act of inspiration for 
conveying air impregnated with remedial agents to the 
diseased structures themselves, in the treatment of dis- 
orders of the lungs and air-passages, has attracted the 
attention of physicians from the remotest period ; and 
even in the writings of Hippocrates there is a record of 
an excellent apparatus for the purpose of administering 
inhalations. 

Gases, vapors, and fumes may be inhaled diffused in" 
the air of the apartment occupied by the patient, or they 
may be conveyed directly to the air-passages by means 
of some special contrivance. Inhalations of the former 
sort are more or less continuous, and of the latter sort 
more or less intermittent. 

Inhalations of oxygen, nitrous oxide, carbonic acid, 
chlorine, and other gases, can be administered at ordinary 
temperatures ; and so, also, the vapors from iodine, crea- 
sote, carbolic acid, camphor, ether, chloroform, nitrate of 
amyl, and nascent chloride of ammonium. 

2 



14 THE INHALATION OF 

The vapors from the volatile ethereal oils, from water, 
and decoctions of aromatic, resinous, and narcotic plants, 
and the fumes from tar, sulphur, arsenic, and mercury, 
are evolved at a more or less elevated temperature; arti- 
ficial heat being employed for the purpose. The material 
from which the vapor is to be evolved, if soluble, may 
be simply added to hot water, or be further heated by a 
lamp, as the case may be ; and comparative uniformity 
of temperature during the inhalation may be secured by 
placing the vessel containing the evaporating substance 
in a sand or hot- water bath, or by keeping a flame be- 
neath it. The air to be impregnated with the volatile 
substance may simply pass over the vapor as it is evolved, 
or may be forced through the warm water or medicinal 
solution, and become impregnated in its passage. The 
latter plan is that most frequently adopted. 

The fumes of substances volatile by combustion are 
produced by throwing the substance upon heated metal, 
or simply upon burning coals, or by slow ignition in 
substance or in the form of pastilles, saturated paper, 
and the like ; or the material may be packed in a pipe, 
or rolled into cigarettes, and smoked after the manner 
of tobacco. 

The vapors of solid substances volatile at ordinary 
temperatures, as of iodine, camphor, and chloral, are 
usually inhaled from some sort of tube in the interior of 
which the substance is confined by light wads of cotton 
or w r ool, one end of the tube being placed in the mouth 
or nostril, and inspiration being made through it. Certain 
liquid substances of great volatility may be dropped 
upon cotton or sponge, and placed in a similar reservoir; 
or the saturated cotton or sponge may be placed in the 
bottom of a wide-mouthed bottle or jar; or the substance 



AIRS, GASES, VAPORS, AND FUMES. 15 

itself may be simply poured upon the bottom of such a 
vessel. 

Even those substances usually administered warm are 
sometimes administered at ordinary temperatures ; and 
some authors* have expressed a decided preference for 
cold, over hot inhalations, in chronic complaints. 

When the patient is not kept more or less continuously 
in an artificially medicated atmosphere — a respiratory 
dietetic plan of treatment not often adopted at the pres- 
ent day — the inhalations are administered medicinally 
at appropriate intervals, and continued for a few minutes 
or for a longer period, according to the nature of the 
remedy, the character of the malady, and the specific 
object in view. Medicinal inhalations are usually ad- 
ministered to best advantage before eating ; because, as 
a rule, they are less apt to offend the empty than the 
full stomach ; while, moreover, if they are to be of ser- 
vice, they often stimulate the appetite, or at least pro- 
mote the desire for food. After having taken an inha- 
lation, the patient should be confined to his apartment, 
or at least to the house, for from fifteen to thirty min- 
utes, especially if warm vapors have been inhaled ; as 
sudden exposure of the warmed-up respiratory tract to 
the change of temperature between in-doors and out-of- 
doors, may, under unfavorable conditions, be followed 
by injurious consequences. 

The proper method of inhaling gases and vapors from 
an inhaler must be acquired by the patient, otherwise 
the vapor will merely be drawn into the mouth and 
reach the pharynx, and if it mixes at all with the air in 
the lungs, will do so by diffusion ; but with a little effort 
the manner of effecting penetration into the lungs can 

* Coxe, On Inhalations, Philadelphia, 1845, pp. 90, 116. 



16 THE INHALATION OF 

be readily acquired. That it is no easy matter to inhale 
a vapor, and that, consequently, when stramonium and 
the like are smoked, instead of being carried into the 
lungs by the inspiratory current, they impress the sys- 
tem sympathetically or otherwise by their effect upon 
the mucous membrane or on the terminal nervous dis- 
tribution of the pharynx, can be made evident by at- 
tempting to inhale the smoke from an ordinary segar. 
As usually smoked, none of the smoke passes the glottis, 
and when the attempt to inhale is made, it will be found 
to require considerable effort, and induce a paroxysm of 
cough with disagreeable sensations, even in the persons 
of inveterate smokers. A volume of smoke can be 
retained in the mouth for a considerable time without 
embarrassing respiration ; and this is proof positive that 
inhalation is being carried on behind the velum through 
the nares. When the nostrils are compressed the effect 
is different. 

If the smoke, after having been taken into the mouth, 
be blown into a wide-mouthed vessel, a tumbler for ex- 
ample, and a deep inspiration be made of the smoke as 
it is playing about in the receptacle, the lungs will 
become charged, under subjective phenomena promptly 
perceptible to the patient. When, therefore, vapor has 
been drawn into the mouth from an inhaler, a deep in- 
spiration should follow the suction effort, so that the air, 
in entering the lungs, will carry a portion of the vapor 
with it. If this cannot be done, the vapor or smoke may 
be blown into a tumbler and inhaled from that. If the 
vapor is forced into the mouth mechanically, by com- 
pressed air, from a compression bellows for instance, it 
can be inhaled much more readily than by the mere effort 



AIRS, GASES, VAPORS, AND FUMES. 17 

of aspiration. This method is of advantage in adminis- 
tering inhalations to debilitated or bedridden patients. 
Care must be taken to keep the compressing apparatus 
in good order, so that it shall not suck up any of the 
fluid instead of forcing air through it. 

The importance, then, of seeing that patients inhale 
properly is self-evident, for if they are merely directed 
to inhale, and not taught how to do so effectually, in 
many instances the attempt will be futile, and the method 
of course fall into disrepute. 

One great mistake often made in administering inha- 
lations, is in having the water from which the vapor 
rises too hot. Usually a temperature of from 110° to 
120° F. is all that is requisite to disengage the volatile 
ingredients of vegetable substances, and the greater the 
volatility of the substance to be used, the less the degree 
of heat that will be required. 

Dr. John Harwood,* of London, endeavored by ex- 
periment to determine the best temperature for inhala- 
tion, as also the temperature of the water necessary to 
produce the desired temperature of inhalation. This he 
did by retaining the bulb of a delicate thermometer in 
the vapor within the inhaler, and successively passing a 
volume of twenty cubic inches of atmospheric air at a 
given temperature through the instrument, this volume 
of air being similar to that which is received by the 
lungs during diminished or impaired respiration ; and 
the passage of the current through the inhaler was con- 
ducted in the succession of the inspirations of breathing. 
It was thus ascertained that atmospheric air of 57° F., 

* On the Practical Use of Inhalations, etc., London, 1889. 



18 THE INHALATION OF 

when combined in its passage through the inhaler, with 
the vapor arising from 

Water at 100° afforded an inhalation of 79° 

U ci 110 o ci u u c< 84° 

u u j 20° n " « «« 88° 
(i « ]3o° ci u ic ci 930 

II « 14QO 11 u U 11 990 

11 ci 250° << ci u u 204° 

Dr. Harwood recommends water at from 110° to 135° 
F. as the best scale for ordinary purposes, 130° being 
the most suitable temperature. 

By taking the mean between the temperature of the 
apartment, and that of the medicated fluid, we can esti- 
mate the temperature of the vapor. It is not well, 
except the object be to promote active secretion, to 
exceed the normal temperature of the air in the lungs. 

Many volatile substances may be inhaled from any 
simple vessel, as a bowl, jug, or tea-pot; the patient 
breathing directly over the vessel, or through a funnel 
with a wide tube. When it is desired to impress the sys- 
tem more fully, a cloth may be loosely thrown over the 
head, if necessary, to insure more copious respiration of 
the vapor; care being taken that due access of the air 
is not impeded. This method of inhalation sometimes 
induces congestion of the head and face, and, therefore, 
should not be carelessly recommended. Inhalers require 
a special mouth-piece to be placed within the mouth or 
over it, or a nozzle to be inserted into the nostril. This 
mouth-pieoe may communicate directly with the vessel, 
or what is almost always preferable, be attached to it by 
means of flexible tubing. All inhalers consist essentially 
of a reservoir with two openings ; one to admit the en- 
trance of air, and the other to afford it egress after im- 



AIRS, GASES, VAPORS, AND FUMES. 19 

pregnation with the vapor. The latter opening may con- 
stitute the mouth-piece itself, or communicate with it by 
rigid or flexible tubing. In some inhalers the opening for 
air is closed by a perforated cork, through which a. tube 
of glass, metal, or hard rubber dips down nearly to the 
bottom of the vessel, so that the air must pass through 
the fluid in the body of the inhaler before it reaches the 
exit or inhaling tube. 

The mouth-piece of the inhaling tube may be simply 
tubular, so as to be placed within the mouth, or ter- 
minate in a wide funnel-shaped orifice, so as to be placed 
in front of the mouth. The latter form is often better 
adapted to mere inspiration, the former requiring in 
some measure a combined effort at suction, which com- 
plicates the process, and renders it too fatiguing for 
debilitated and bedridden patients. 

Inhalers. 

There are more varieties of inhalers than are worthy 
of mention. A description will be given of a few of those 
most deserving of notice. 

The inhaler devised by John Mudge,* the type of 
most modern inhalers, consists of a pewter mug (Fig. 1) 
of the capacity of a quart, with a hollow handle. The 
interior of the handle communicates below with the in- 
terior of the vessel, and a number of perforations in the 
upper part of the handle permit the ingress of the exter- 
nal air during inspiration through the apparatus. A 
tightly fitting lid of some thickness covers the mug. A 
central perforation in this lid permits the attachment of 
a flexible tube through which the patient is to inhale ; 

* A Radical and Expeditious Cure for a Recent Catarrhous 
Cough, etc., London, 1778. 



20 



THE INHALATION OF 



while a second perforation incloses a ball-valve of cork, 
so placed as to permit the egress of air, but prevent its 
ingress. 



Fig. 1. 




Mudge's Inhaler (from Mudge). 
a, perforated plate to cover the orifice of exit for expired air ; b, cork valve; 
c, tube of orifice through which the air is inhaled ; d, flexible tubing ; e, mouth- 
piece ; /, orifices for entrance of air. 

The mug being filled to two-thirds of its capacity, the 
water of course rises in the handle to the same level ; 
and, therefore, when the patient inspires through the 
flexible tube, the air rushes through the handle of the 
mug into the water, and out through the inhaling-tube. 
When the patient expires through the tube, the air of 
expiration passes into the free space beneath the cover, 
and is expelled out of the second perforation in the 
eover, lifting the cork-valve in its egress. All the 



AIRS, GASES, VAPORS, AND FUMES. 



21 



holes are large, so as to afford the greatest freedom of 
respiration, both acts of which are performed through 
the apparatus without removal of the mouth-piece. 



Fig. 2. 



Fig. 3. 






Wolfe-Bottle Inhaler. 



Simple Modification of Wolfe- 
Bottle Inhaler. 



An efficient inhaler in common use is composed of a 
three-necked Wolfe's bottle (Fig. 2). Two of the corks 
are perforated. Through one an air-tube passes nearly 
to the bottom of the vessel ; through the other the in- 
haling-tube passes a short distance. When in use, the 
bottle being partially filled with liquid, the external air 
passes through the straight tube into the liquid, and 
then out of the bent tube, to which tubing and mouth- 
piece may be attached. A wide-mouthed bottle, with a 
doubly-perforated cork (Fig. 3), answers the same pur- 
pose, and can be arranged extemporaneously at short 
notice. The bottles should be of the capacity of a quart, 
and the tubes of large calibre, so that respiration may 
take place with as little impediment as may be. The 
frreat defect in most modern inhalers is that the tubes 



22 



THE INHALATION OF 



are insufficient in calibre for the air to be drawn through 
them by mere aspiration, so that an accessory movement 
of suction becomes requisite. 

In using these more simple inhalers, the tongue can 
be placed against the end of the tube in the moutdi dur- 
ing expiration, so that the expired air passes out through 
the nostrils, or otherwise the mouth must be removed 
from the instrument at each expiration, in order that 
the expired air shall not pass into the inhaler. Of late 
years, mouth-pieces to inhalers have been provided with 
valves, which permit the medicated air to pass into the 
mouth in inspiration, and direct the expired into the 
atmosphere, so that none of it contaminates the air en- 
tering the reservoir or apparatus. One of the best of 
these contrivances has been devised by Dr. Beigel, of 
London,* the accompanying sketch of which in section 
(Fig. 4), sufficiently explains its construction: "The 
two valves (A and B) are made of vulcanite, and, acting 



Fig. 4. 




Beigtl's Mouth-Piece (from Beigel). 



extremely easily, close and open with great precision. 
It is obvious that the inhalation with each inspiration — 
during which the valve B gets closed — -takes place in 

* On Inhalation as a Means of Local Treatment of the Organs 
of Respiration by Atomized Fluids and Gases. London, 1866, 
p. 75. 



AIRS, GASES, VAPORS, AND FUMES. 23 

the direction of the arrow at A ; while, during expira- 
tion, A closes, and the expired air escapes in the direc- 
tion of the arrow at B." 

The apparatus of Sir Charles Scudaraore is substan- 
tially on the same principle as that of Mudge. It is a 
glass vessel with a double neck; though a wide-mouthed 
bottle, with two perforations through the closely-fitting 
cork, will answer the same purpose. Sir Charles directs 
that the water in the inhaler should be about an inch in 
depth, and to this the mixture to be inhaled must be 
added. He deems it important that the bottle should 
be large and the tubes capacious. The tube issuing 
from the bottle should be upright, passing gradually 
into a slight curve, so that the vapor should not be 
much cooled during its egress. The ingress tube should 
dip very close to the bottom of the vessel, that all the 
air introduced may become impregnated. The patient 
should be desired to inhale by a combination of a suc- 
tion effort and a pretty deep inspiration ; then to drop 
the under lip from the mouth-piece and make a free ex- 
piration, and thus continue the process, pausing occa- 
sionally to avoid fatigue, which would more certainly 
ensue by breathing quickly, or using an inhaler with 
small tubes, or containing too large a quantity of water. 

In fact, most of the inhalers in use are modifications 
of Mudge's. They are made of glass, earthenware, or 
metal. The latter are stronger, but liable to corrosion, 
so that they cannot be employed promiscuously with 
any agent; the others do not have this disadvantage, 
and can be kept more cleanly, but they are liable to 
fracture, and to become cracked in applying or with- 
drawing heat. 

One of the most complete instruments of its kind is 



21 



THE INHALATION OF 



the eclectic inhaler of Mackenzie* (Fig. 5), composed of 
porcelain. 

a Fig. 5. 




Mackenzie's Eclectic Inhaler (from Mackenzie). 

" The inhaler consists of three parts — a, b, and c. a 
is an open vase, and is essentially the containing vessel, 
into which the hot water and medicated solution are 
put. It is shown in A, with a pint of water in it; 
above the water-line is a large space for the steam, b is 
a kind of lid, resembling an inverted tumbler. It is 
shown in A, forming the lid of the containing vase, and 
in b with the sides of the vase drawn diagram matically. 
The bottom of the tumbler forms the covering of the 
vase, and the sides of the tumbler dip down into it, 
leaving an air-chamber between the two parts. When 
the vase has its proper quantity of water, the sides of the 
inverted tumbler or lid dip down only about half an 
inch below the water-line. The circumference of the lid 



* The Pharmacopoeia of the Hospital for Diseases of the Throat. 
London, 1872, p. 68. 



AIRS, GASES, VAPORS, AND FUMES. 25 

is perforated with small holes, as seen at x, and the cir- 
cumference of what would be the rim of the tumbler is 
also perforated in the same way at z. The apertures, 
both above and below, communicate with the air-cham- 
ber. "When the patient inhales, air rushes through the 
various holes above at x, then through the air-chamber, 
again through the medicated fluid, and finally up to the 
mouth-piece, as shown by the course of the arrows. In 
the centre of the upper surface of the lid is a projecting 
nozzle, to which is attached a flexible tube, provided at 
its extremity with a double-valve earthenware mouth- 
piece. This mouth-piece may be either pipe-shaped (p) 
and held in the mouth, or it may terminate in a large 
oval cavity (m), into which the mouth is introduced. 
There is an opening in the lid, through which a ther- 
mometer, registering high temperatures, passes into the 
water. 

" c is a stand, on which the vase rests, and is made 
hollow, so as to hold a spirit-lamp." 

Carrick has modified this inhaler by using a metallic 
vase, and covering the perforated cylinder with flannel. 
It is smaller than the eclectic inhaler, and requires much 
less water ; and the thermometer bulb is in the steam 
space. In the only one I have seen the thermometer 
was very inaccurate. 

In another variety of inhalers, provision is made for 
placing a spirit-lamp beneath the vessel, so as to main- 
tain the evolution of the vapor and the temperature 
during the entire time of the inhalation. One of the 
simplest and best of these is that of Mandl* (Fig. 6). 

It consists of a globular glass vessel with two tubu- 

* Traite pratique des maladies du larynx et du pharynx, Paris, 
1872, p. 609. 



26 THE INHALATION OF 



lures in the upper portion; one simply to admit the air, 
and the other, longer, to give attachment to the flexi- 

Fig. 6. 




Mandl's Inhaler or Fumigator (from Mandl). 
A, stand ; B, lamp ; C, support ; D, reservoir ; E, orifice to admit air ; F, 
orifice for attachment of flexible tubing ; G, wooden connection by which to 
hold tube ; H, additional tubing for mouth-piece. 



ble tubing which carries the mouth-piece. It rests on a 
stand over a spirit-lamp. The inspired air as it passes 
over the vapor becomes impregnated with it, and the 
expired air escapes by the opening of entrance. The 
vapor being evolved by heat there is no necessity for an 
air-tube to dip into the fluid. The amount of heat 



AIRS, GASES, VAPORS, AND FUMES. 27 

necessary to evolve the vapor is regulated by altering 
the size of the wick, or by the occasional removal of the 
lamp. 

A tubulated retort answers the purpose perfectly. 
Waldenburg,* imitating the principle employed by 
Hippocrates, closes the tubule of the retort with a 
stopper while the vapor is being evolved, so as to pre- 
vent access of the air into the retort itself, and leads a 
tube from the beak of the retort into a cylindrical 
mouth-piece of large orifice. The vapor becomes mixed 
with air in this cylinder, and there becomes cooled and 
condensed. I have often used a mouth speculum for 
the same purpose, leading the free extremity of the in- 
haling tube within the funnel-shaped portion, where 
the patient holds it gently between two of his disen- 
gaged fingers. In this way the outer air enters the 
funnel around the delivery tube, and is there mingled 
with the gas or vapor after its escape. 

Charriere, of Paris, has constructed what appears to 
me to be an excellent apparatus for supplying vapors 
for inhalation in large volume.f The vapors are evolved 
in a vessel by means of a spirit-lamp. A flexible tube 
as capacious in calibre as the reservoir itself surmounts 
the latter, and terminates in a mouth-piece which covers 
the mouth. 

Dr. John Snow r , of London, contrived an inhaler 
especially adapted for the inhalation of opium, but also 
applicable to many other solid medicines. It is made 
chiefly of tin, and consists of a cylindrical chamber, be- 
tween four and five inches in diameter, and three or four 

* Die locale Behandlung der Krankheiten der Athmungsorgane, 
Berlin, 1872, p. 584. 
f Gaz. med., Paris, Jan. 1850, p. 53. 



28 THE INHALATION OF 

inches deep, under the centre of which a spirit-lamp is 
placed. The bottom of the inhaler consists of a thin piece 
of talc, on which is placed a small capsule of Berlin ware, 
for the purpose of holding the extract of opium. A por- 
celain funnel-holder, which is placed on the talc, keeps 
the capsule exactly over the flame of the lamp. The talc 
allows sufficient heat to be transmitted to the opium, 
without conducting it to the sides of the inhaler, and, 
consequently, the air which is inhaled is not unduly 
heated. The lid of the inhaler is movable, and it is 
provided with a delicately balanced valve for the ad- 
mission of air, and is connected to a face-piece by means 
of an elastic tube of wide calibre. This face-piece 
covers the mouth and nostrils, and is a modification of 
that of Hawksley. It is flexible, the sides and margin 
consisting of thin sheet lead, lined with oiled silk and 
covered with leather, with an expiratory valve which 
can be moved more or less to one side from the opening 
it covers, so as to admit unmedicated air whenever the 
vapor feels too pungent. 

Langlebert's apparatus is a ring-shaped copper vessel, 
the cover of which is pierced with four holes, through 
which the vapor of water escapes when the water in the 
vessel is heated by a lamp. The flame of the lamp 
passes through the centre of the vessel, and thus vola- 
tilizes the mercury or other substance contained in an 
iron capsule placed above the orifice for the passage of 
the flame. The substance volatilized is thus mingled 
with warm watery vapor, a circumstance of considerable 
practical importance in some cases, as in the diffusion of 
vapors of tar and other substances. 

Fig. 7 represents Bumstead's Calomel Vaporizer, 
which can be used for other substances also. Water is 



AIRS, GASES, VAPORS, AND FUMES. 29 

placed in the ditch at top, which surrounds the recep- 
tacle for the calomel, the vapor of which thus becomes 
mingled with the vapor of water. 

Fig. 7. 




<-'flEYAIO£f}S~CQ 

Bunistead's Calomel Vaporizer. 

A special: sort of intra-oral inhaler was introduced by 
Prof. Max Langenbeck,* consisting of a flattened globe, of 
boxwood or ivory, varying in diameter from three-quar- 
ters of an inch to an inch and a half, formed of two 
halves, which are screwed together, after some medicated 
cotton, wool, or sponge has been placed in the interior ; 
a number of holes on each side permitting the passage 
of the air. The instrument is placed partially within 
the mouth, the lips of which compress the projecting 
portion. Prof. Langenbeck employed this instrument 
for treating many general affections by inhalation, as 
well as affections of the respiratory organs themselves. 

An instrument virtually the same, but made of hard 
rubber, has been contrived by Dr. M. S. Buttles,f of 

* Deutsche Klinik, 1861, No. 13, p. 129. 
f Med. Record, 1866, p. 44. 
3 



30 THE INHALATION OF 

New York, to which a rubber tube may be attached, so 
that the instrument may be entirely concealed within 
the mouth, the tube remaining outside to permit access 
of atmospheric air. These instruments can be modified 
for insertion into the nasal passages, in treating nasal or 
naso-pharyngeal affections. 

Dr. Pomeroy,* of New York, has modified this instru- 
ment, by substituting a reservoir of glass (Fig. 8), so as 

Fig. 8. 




Pomeroy's Inhaler. 

to permit the use of agents which would act upon hard 
rubber. 

Dr. A. P. Merril, of the same city, devised a very ele- 
gant affair of hard rubber on the same principle, much 
of the shape of a lead-pencil, designed especially for in- 
halations through the nostrils. 

An ordinary tobacco-pipe answers the purpose fully. 
This method is adapted only for substances volatile at 
ordinary temperatures. Pipes of glass or metal are 
sometimes used for cold inhalations. 

Solutions of chlorine, iodine, tar, the balsams, tur- 
pentine, preparations of camphor, etc., may be diffused 
in any quantity through the air of an apartment by 
means of various contrivances. Dr. Corriganf devised 

* Med. Kecord, 1866, p. 44. 

f Observations on the Exhibition of Kennedies, in the Form of 
Vapor, in Pulmonary Diseases ; with Description of a Diffuser 
for the Administration of Iodine, Chlorine, etc. Dublin Jour. 
Med. Sci., 1834, 43, p 94, illustrated. 



AND FUMES. 31 

an apparatus for this purpose, fulfilling the following 
requisites: " 1st. That the apparatus should be simple in 
its construction and easily kept in order; 2d. That it 
should be capable of keeping up a supply of vapor for 
any length of time, and that the evolution of the vapor 
should be steady, and should be easily regulated ; 3d. 
That it should also furnish a sufficient supply of aqueous 
vapor, to prevent any irritation of the larynx, or lining 
membrane of the air-tubes; and 4th, and most impor- 
tant of all, that its employment should entail neither 
trouble nor fatigue on the invalid. 

" This apparatus consists of a light, open, iron-wire 
frame, about eighteen inches high, at the bottom of 
which is a spirit-lamp ; at the proper height above this 
is an evaporating porcelain dish, about six inches in 
diameter ; and above this is a glass globe, with its neck 
downwards. In the neck of the globe is a cork, bored, 
and through the opening is drawn, moderately tight, a 
short plug of cotton wick, such as is used in a spirit- 
lamp ; in the glass globe, opposite the neck, a pin-hole 
is drilled, to allow air to pass in, according as the fluid 
within drops out through the neck. To use it, the por- 
celain dish is filled with hot water, the spirit-lamp is 
lighted, and as soon as the water in the dish has begun 
to boil, the glass globe containing the tincture of iodine 
(if this be the substance used) is placed in position. The 
rate at which the fluid in the globe shall percolate the 
cotton wick and drop into the hot water beneath is easily 
regulated. If it should not drop with sufficient rapid- 
ity, one or two of the threads of cotton maybe removed. 
Should it drop too rapidly, this is corrected by pressing 
in the cork more tightly, or introducing one or two ad- 
ditional threads of wick," 



32 



THE INHALATION OF 



In the absence of this apparatus Dr. Coxe* found a 
common nursery lamp to answer very well. 

An apparatus devised by W. G. Walford,f for evolv- 
ing chlorine gas, consists simply in a ground stopper 
introduced into the tube of a funnel, so as to allow fluid 
to pass through guttatim. If muriatic acid be allowed 
to drop on to a quantity of chloride of lime, at the rate of 
three or four drops a minute, chlorine gas will be evolved. 

Lewin, of Berlin, devised an apparatus for evolving 
the vapors of sal ammoniac in a nascent state without 
the employment of heat or fire. 




Lewin's Apparatus for the Inhalation of Nascent Vapors of Sal 
Ammoniac. (From Lewin. ) 

a, glass vessel, containing strong aqua amnionic ; b, glass vessel containing 
muriatic acid; c, glass vessel containing distilled water, slightly acidulated; d, 
rubber tubing, to which is attached the mouth-piece; e, f, connecting glass 
tubes ; g, h, glass tubes for admittance of atmospheric air. 

This apparatus (Fig. 9) consists of a series of three 



* Op. cit., p. 95. 



f The Lancet, Dec. 5th, 1874, p. 823. 



AIRS, GASES, VAPORS, AND FUMES. 33 

Wolfe's bottles. One of these contains a little caustic 
water of ammonia, another a little pure muriatic acid, 
and the third bottle, which is partially filled with water, 
receives a tube from each of the other bottles, these 
tubes reaching to the bottom of the water, while from a 
third opening in the cork the vapor extrudes through an 
exit tube, to which a mouth-piece is attached by india- 
rubber tubing. Now, as the effort of inspiration draws 
the liquids from the first two bottles into the third bottle, 
their ingredients combine to form the sal ammoniac 
vapor, which, during its passage through the water, be- 
comes cleansed of impurities. If it is desired to medi- 
cate the nascent sal ammoniac with creasote, or an oleo- 
balsamic mixture, or bitter-almond water, or the like, 
all that will be necessary will be to add it to the water 
in the third bottle. 

Atmospheric Air. 

Systematic inhalation of atmospheric air is often of 
great therapeutic service. Every one is aware of the 
benefits derived from residence in mountainous regions, 
and from the pedestrian tours and other gymnastic ex- 
ercises to which pugilists are subjected during training, 
which, developing . their respiratory capacity, increase 
their strength and powers of endurance. 

In individuals with weak lungs, that is to say, with 
deficient normal respiratory capacity, in those of seden- 
tary habits, whose pulmonary organs are rarely ade- 
quately aerated, the habitual employment of a number 
of forced inspirations of fresh air at stated hours, will 
soon exert a beneficial influence. The result will be 
facilitated by forcibly straightening out the shoulders, 
either voluntarily or with the aid of an assistant, during 



34 THE INHALATION OF 

the inspiration, which should be slow and through a 
small oval aperture, or through a tube of some kind, 
round which the lips are closed; the position of the 
arms being maintained during the inspiration. Running, 
leaping, dancing, and the like, induce a demand for in- 
creased and deepened inspiration, which is very effica- 
cious in instances where such violent exercise is not 
contraindicated. I have for a Ions: time, in suitable 
cases of deficient aeration of the lungs and expansion 
of the chest, been in the habit of advising the daily use 
of the jumping-rope, a few minutes at a time, " back- 
door," as the children term it. In young ladies, espe- 
cially those of sedentary habits or occupations, or those 
kept too closely confined at school or at the piano, I have 
found this exercise of admirable utility in promoting 
due expansion of the lungs and development of the 
chest, as well as in overcoming a disposition to round 
shoulders. As a matter of course, corsets, and every 
other bandage or article of apparel which constricts the 
chest or abdomen, should be removed during the ex- 
ercise. 

Systematic forced respiration of atmospheric air, 
through an inhaler or a long tube, three times a day, 
for half an hour each time, has been highly recommended 
by Dr. Ramadge,* in the early stages of consumption, as 
a means of enlarging the chest, and increasing the per- 
meability of the lungs; the increase in the natural re- 
spiratory murmur becoming more distinct at the end of a 
few weeks. This author attached but little value to the 
substances inhaled ; but inasmuch as patients are more 
willing to receive into their lungs something having 

* Consumption Curable, London, 1836, 3d ed., p. 97. 



AIRS, GASES, VAPORS, AND FUMES. OD 

sensible properties, rather than pure atmospheric air, he 
was in the habit of recommending a handful of hops, 
a little ether, vinegar, or a tablespoonfnl of spirits of 
turpentine to be added to the warm water in the inhaler. 

Forced expiration and inspiration of common air has 
been found a successful expedient in terminating a 
paroxysm of spasmodic asthma. 

Dr. J. S. Monell,* of New York, has recorded his 
own case: 

In December, 1865, about nine o'clock one evening, he was 
having a severe attack of asthma, to which he had been subject 
for fifteen years. He placed himself standing at the foot of his 
bed, with his arms folded upon the foot-board for a pillow, the 
forehead resting upon the folded arms, and the feet placed at 
a sufficient distance to make a partial semicircle of the body. 
While laboring severely for air, the thought occurred to him to 
cease breathing for a few seconds. He did so, and after several 
trials experienced some relief. He then expired all the air that it 
was possible for him to do, after which he determined not to in- 
spire again until he found it absolutely necessary. He succeeded 
in waiting several seconds, then inspiration was carried to its fullest 
capacity, and retained with great effort for many seconds. This 
act of forced expiration, waiting, thorough inspiration, and again 
waiting, was continued for some fifteen minutes, and to his de- 
light, the spasm was perfectly relieved. He has since relieved 
several similar attacks by the same method, in less than two min- 
utes. He has advised this course for many others, and their testi- 
mony has been uniformly satisfactory, except in one instance, that 
of an aged lady with heart disease. It requires a great effort on 
the part of the patient to perform this act. The first attempt at 
retaining the inspired air during the asthmatic attack, will cause 
the patient to think he cannot continue it, but perseverance will 
soon delight him with relief from the spasm. 

I have frequently prescribed this experiment, and the 
results have been encouraging in a number of instances. 
This method is similar to that employed by Laennec, 

* The Medical Record, August 15th, 1866. 



36 THE INHALATION OF 

according to whom,* if an asthmatic patient be induced 
to hold his breath for a short time, or to count aloud as 
many numbers as possible without stopping, and then 
quietly to commence breathing again, the spasm appears 
to be in a manner surprised into relaxation, and the air 
can be heard entering all parts of the lungs for the next 
breath or two ; after which, the ordinary state of things 
returns. 

The inhalation of cold or cool atmospheric air, as a 
remedy in pulmonary diseases, w T as advised by Dr. C. 
Drake, of New York.f He found the method of most 
value in chronic catarrhs of long standing. He employed 
these inhalations at temperatures varying from 32° F. 
to 3° or 4° below zero, and found them to afford comfort, 
relieve cough, and render the pulse slower and fuller. 

Dr. RamadgeJ was, at one time, in the habit of re- 
sorting, in the treatment of consumption, to the inhala- 
tion of air artificially cooled, for the purpose of exciting 
an intercurrent catarrhal inflammation of the mucous 
membrane of the air-passages, the influence of which, he 
claimed, often led to the recovery of the patient. Dr. 
Coxe, of Baltimore, § confirmed this result in his own 
experience. 

Prof. Langenbeck placed ice in the reservoir of his 
oral inhaler, 1 1 for the purpose of cooling the inspired air 
in cases of haemoptysis, in pulmonary consumption, and 
in fevers. 

Much more recently, If the inhalation of cold and dry 

* Wood's Practice, Philadelphia, 1858, 1, p. 883. 
T Am. Jour. Med. Sci., 1828, vol. ii, p. 53, and vol. iii, p. 53, 
with an illustration of a refrigerator. 

t Op. cit., p. 101. I Op. cit. || See p. 29. 

\ Med. Times and Gaz., January 16th, 1869, p. 69. 



AIRS, GASES, VAPORS, AND FUMES. 37 

air has been recommended as a remedy for the condition 
associated with separation of fibrin from the blood in 
inflammatory diseases. This air, it is stated, will bring 
down the temperature several degrees. 

Condensed and Rarefied Air. 

The influences exerted upon the human economy from 
rarefaction of the atmosphere at high altitudes have 
long been known. Respiration and heart-action are 
accelerated, while there is an afflux of blood to the 
periphery of the body, leading to hyperemia and con- 
gestion, sometimes eventuating in haemorrhage from 
mucous outlets, as the nose, mouth, and conjunctiva. 
There is also a degree of lassitude independent of exer- 
tion. 

The influence of condensed air upon animal and veg- 
etable life especially attracted the attention of scientific 
men in the latter part of the eighteenth century ; and 
the results of certain experiments upon animals led to 
the suggestion that the respiration of compressed air 
might be beneficial in certain cases of disease. To these 
have been added the observations of the effects of tem- 
porary sojourn in diving-bells and at the bottom of deep 
mines. 

A communication to the Parisian Academy of Sciences 
was made on this subject by E. Tabarie, on December 
7th, 1832,* and in August, 1835, M. Junod reported to 
the same body the results of his own experiments upon 
the human organism. Under the directions of Tabarie, 
at a later date, dating from 1838, the method was em- 
ployed in the treatment of disease by Pravaz, Bertin, of 

* Comtes-rendus, t. vi, p. 896. 
4 



38 THE INHALATION OF 

Montpelier, and Milliet, of Lyons — who reported some 
cases of phthisis apparently benefited in the first and 
second stages — and others. 

Tabarie's apparatus consisted of a wrought-iron spher- 
ical chamber, capable of accommodating a dozen patients, 
into which air was forced by a steam pump to the pres- 
sure of from one-half to two-thirds of an atmosphere. 
An arrangement attached to the apparatus afforded 
egress to the air expired by the patients. Each sitting 
lasted two hours, during the first half hour of which 
the requisite pressure was gradually produced, and, after 
having been maintained for an hour, it was gradually 
withdrawn during the last half hour. 

Milliet* records the results in twenty-two cases, com- 
prising asthma, congestion of the lungs, emphysema, 
hepatization, phthisis, bronchial catarrh, chlorosis, hoop- 
ing-cough, laryngo-tracheitis, broncho-tracheitis, bron- 
chitis and chronic pneumonia. 

Bertinf recorded, in 1855, thirty-five observations in 
bronchitis, acute and chronic, chronic angina with 
aphonia, chronic pharyngitis, aphonia, bronchial catarrh, 
pulmonary oedema, emphysema, asthma, haemoptysis, 
chronic pneumonia, and phthisis. 

Sandahl, of Stockholm, reported, in 1862,J the sta- 
tistical observations of three hundred and fifty-three 
cases, of which there were one hundred and forty of 

* De Pair comprime comme agent therapeutique, Lyon, 1854. 

f Etude clinique de l'emploi et des effets du bain d'air corn- 
prime dans le traitement de diverses maladies, Paris, 1855. Also, 
Etude clinique de l'emploi et des effets du bain d'air comprime" 
dans le traitement des maladies de poitrine, notamment dans le 
catarrh chronique, Pasthme, et la phthisis pulmonaire, Paris, 
1868, pp. 774. Pveviewed in Gaz. hebd., 1868, No. 50, p. 794. 

J Om Verkningarne of fortatad Luft. 



AIRS, GASES, VAPORS, AND FUMES. 39 

diseases of the larynx and trachea, seven of pneumonia, 
twenty-two of asthma with emphysema, thirty-one of 
tuberculosis, five organic valvular insufficiency of the 
heart, ten of anaemia, and thirty-five of aural catarrh. 
Subsequently,* Sandahl has recommended the use of 
this agent in the treatment of hooping-cough. 

Attempts were soon made to establish a physiological 
basis for the therapeutic employment of compressed air, 
and the resulting labors of a number of investigators 
have been published in the medical periodicals and in 
monographs. 

The subject was most thoroughly studied by von 
Vivenot, Jr., who has presentedf everything of value 
up to the appearance of his own work. 

From these memoirs we learn that the first result of 
inhaling condensed air is a prolongation of the respira- 
tory acts, which continues, in a slight degree, for some 
time after leaving the compressed atmosphere. The 
sojourn for one or two hours daily in an apparatus, 
under an extra pressure of about three-sevenths of an 
atmosphere, will gradually diminish the frequency of 
respirations some three or four in the minute. The lung 
capacity is increased at the same time, chiefly by greater 
descent of the diaphragm. Inspiration becomes easier 
and more rapid, expiration slower and more laborious. 
The frequency of the pulse undergoes diminution from 
four to seven beats in the minute, but soon resumes its 
normal rate in the normal atmosphere. The mass of 

* La Tribune mecl , 1868, p. 558; see also Jour f. Kinderkr., 
1867, Nos. 11 and 12; Gaz. raed., Strasbourg, 1868, p. 118. 

f Zur Kenntniss der physiologisehen Wirkungen und. der 
tberapeutiscber Anwondung der verdicbteten Luft. Eine pbysi- 
ologiseb-tberapeutische Untersuchungen. Erlangen, 1868. 



40 THE INHALATION OF 

blood is driven from the periphery of the body towards 
the central organs. Thus gaping, disposition to somno- 
lence, and the like, are induced in consequence of ex- 
cess of blood in the brain. The secretion of urine is 
augmented. The senses of touch, taste, and smell 
become obtunded, and the voice acquires an unnatural, 
metallic clang. The only uncomfortable sensation expe- 
rienced by the healthy subject is said to be a sense of 
pressure upon the tympanic membrane, which can be 
relieved by the well-known procedure of Valsalva for 
inflating the Eustachian tube. 

The physiological effect of compressed air being to 
drive the blood from the periphery, it follows that con- 
gestions, tumefactions, inflammations, excessive secretion, 
and the like, at the peripheral portions of the circula- 
tory system should be relieved by subjection to the 
treatment. The ease afforded to respiration suggests its 
employment in cases with which dyspnoea is associated ; 
and we find its chief application, in fact, in pulmonary 
emphysema, asthma, and chronic bronchitis. The aug- 
mentation of vital capacity of the lungs acquired by 
the process, suggests its employment in cases of insuffi- 
cient expansion of thorax, and therefore in early, non- 
febrile cases of phthisis and tuberculosis. 

Tabarie's apparatus was modified by Gustav Lange, so 
as to admit of rarefaction of the air also; and in this, and 
various other modifications, it has been extensively em- 
ployed in a number of continental cities and resorts for 
invalids. In Great Britain, and still more so in America, 
hardly any attention at all has been paid to the subject 
in a therapeutical point of view. 

Dr. J. Burdon -Sanderson, of London, in describing* 

* Practitioner, October, 1868, p. 221. 



AIRS, GASES, VAPORS, AND FUMES. 41 

the compressed air-chambers of the brothers Mack at 
Reichenthall, Bavaria, favors the view that compressed 
air exercises a very marked sedative influence both on 
the circulation and the respiration. " The pulse is re- 
tarded, while the respiration not only becomes less fre- 
quent, but appears to be performed with diminished 
effort ; and it is remarkable that these effects, although 
they are most obvious during the time that the patient 
is under pressure, do not entirely cease, when the normal 
conditions are restored.' 7 The cases in which compressed 
air is useful, are those of chronic bronchitis with em- 
physema, the dyspnoea attending which is due to the 
series of changes, consequent on dilatation of the right 
heart, engorgement of the venous circulation, and im- 
pairment of the pulmonary circulation. 

".Dr. Lange maintains that the efficacy of the com- 
pressed air principally rests upon the blood being more 
richly supplied with oxygen, and that a healthier nutri- 
tion is the immediate consequence of it. He proves that 
by the application of compressed air, a considerable in- 
crease of the negative pressure of inspiration and of the 
positive pressure of expiration takes place, whereby the 
power of the muscles of inspiration becomes greater, the 
pressure of the blood in the aortic system is lowered, 
and the frequency of the heart's pulsation diminished. 
The animal heat lowers likewise after the application of 
a compressed air bath, the organs of digestion are placed 
in a better position, whilst the appetite increases, and the 
functions of the bowels are performed with greater ease. 
Increase in secretion of the urine has been observed in 
most of the cases."* 

Dr. Von Liebig, of Reichenholt, as the result of his 
experiments upon compressed air, finds, among other 

* Beigel, op. cit. , p. 71. 



42 THE INHALATION OF 

things, that its inhalation has not in itself any very 
natural effect on the production of carbonic acid. Any 
increase of expired carbonic acid coincides with a greater 
inspiration of atmospheric air, and the quickness of 
respiration has a much greater effect in producing car- 
bonic acid than its depth. The number of respirations 
being reduced under increased pressure, and increased 
under diminished pressure, it seems probable that the 
quantity of carbonic acid expired may be greater under 
the latter circumstances. From his experiments on 
oxygen Dr. Liebig deduces the inference that there is 
undoubtedly increased absorption of oxygen under high 
pressure, relatively amounting to eighteen, and absolutely 
to twenty-two per cent. ; and he attributes much of the 
success of the pneumatic treatment to this increased sup- 
ply of oxygen in the compressed air.* 

The therapeutic application of compressed, and like- 
wise of rarefied air also, has become established upon a 
more practical and available basis, however, by the con- 
struction of transportable apparatus, in which the atmos- 
pheric pressure can be increased or diminished within 
certain limits at will. In residence at elevated altitudes, 
and in temporary sojourn in pneumatic chambers, not 
only are both acts of respiration performed in air at the 
same pressure, but the entire body is also subjected to 
its physical influence. Neither of these effects may be 
desirable. By means of suitable apparatus, however, 
rarefied or condensed air may be supplied to the respira- 
tory surfaces alone, without subjecting the entire body 
to their influence ; and, furthermore, one act of respira- 
tion may be performed in condensed, and the other in 
rarefied air, as may be deemed advisable under certain 

* (Aerz. Int.-Bl.), The Lon. Med. Kecord, July 29th, 1874, p. 472. 



AIRS, GASES, VAPORS, AND FUMES. 43 

diseased conditions. The treatment is no longer confined 
to any special locality or establishment, and is, therefore, 
within reach of patients at their own places of residence. 

The first apparatus constructed for the sole purpose 
under consideration was devised by Ignaz Hauke,* of 
Vienna, but as it has become superseded by better con- 
trivances, it retains, at present, its historic interest only. 
Hauke, at first, hoped to facilitate respiration in croup 
by the aid of this apparatus, but he found his contriv- 
ance inapplicable to the purpose. In emphysema, how- 
ever, and subsequently in pulmonary consumption, he 
found this pneumatic treatment of great value ; and its 
application has since been extended in modified forms of 
other diseases associated with impediment to respiration. 

Dr. Berkart, of London, devised an instrumentf for 
expiration into rarefied air, for use in the treatment of 
emphysema, his object being "to reduce the intravesic- 
ular pressure, and that resulting from it on the tho- 
racic surface of the diaphragm." It is an expiration 
rather than an inhalation apparatus. The patient 
breathes through a tube in communication with the 
cylinder of an exhausting syringe, from which the air is 
to be suddenly withdrawn at the completion of an 
ordinary act of expiration ; the object being to remove 
from the chest a greater amount of air than can be 
expelled by the unaided act of voluntary expiration. 
The tube and mouth-piece are provided with valves 
which conduct the currents of inspiration and expira- 
tion in the desired direction. The instrument is to be 
used twice a day, for a quarter of an hour at a time. 

* Ein Apparat fur kiinstliclien Eespiration und dessen Anvven- 
dung zu Heilzwecken, Wien, 1870. 
f The Lancet, Nov. 25th, 1871. 



44 THE INHALATION OF 

Dr. Dobell* has devised a " residual-air-pump," for 
pumping out the residual air in the lungs, as far as 
possible, in emphysema. It consists (Fig. 10) essen- 
tially of a mouth-tube with a valvular arrangement 
which allows freedom of expiration, but impedes inspi- 
ration to a certain extent, the nostrils being closed or 

Fro. 10. 




Dr. Dobell's Residual-Air-Puinp. 

unused during the process. " In from three to six 
respiratory acts, the expiratory and reserve air is quite 
pumped out, and the diaphragm has risen to the greatest 
height of which it is capable. The patient is then 
obliged to open the mouth and take a deep inspiration, 
Avhich he does much more freely than he could before 
using the instrument, and with a distinct sense of relief 
and comfort. He then closes his mouth upon the pipe- 
end, and repeats the operation." This little instrument 
is portable (it can be placed in the vest pocket) and 
simple, and is intended for the patient's own use. 

One of the most complete contrivances for the admin- 
istration of compressed and rarefied air, if not the very 
best, is the improved pneumatic apparatus of Professor 
Waldenburg,t modeled on the spirometer of Hutchinson, 

* Brit. Med. Jour., Feb. 10th, 1872. 

f Die pneumatisehe Behandlung der Respirations- und Circula- 
tionskrankheiten, im Anschluss an die Pneumatometrie, Spirome- 
trie, und Brustmessung. Berlin, 1875, p. 150, fig 5. 



AND FUMES. 



45 



Fig. 11. 




Waldenburg's Apparatus for Inhalation 
of Condensed and Rarefied Air. 



and applicable to ac- 
curate physiological in- 
vestigation, as well as 
to therapeutic purposes 
(Fig. 11). 

It consists essentially 
of two cylindrical reser- 
voirs of tin or sheet- 
zinc : an outer one open 
at top, and an inner one 
open at bottom or in- 
verted ; the latter slid- 
ing readily within the 
former. Cords attached 
to the upper portion of 
the inner cylinder pass 
over pulleys and carry 
hooks for the attach- 
ment of weights, as may 
be required to draw the 
inner cylinder partially 
out of the outer one for 
purposes of rarefaction 
of the contained air ; 
while on the other hand, 
for purposes of conden- 
sation, the weights are 
placed atop of the inner 
cylinder to press it down 
within the outer one, 
and thus compress the 
air. Sufficient water be- 
ing poured into the outer 
cylinder, the air in the 
inner cylinder is shut off 
from contact with the 



46 THE INHALATION OF 

exterior air, and being thus confined, may be subjected 
to rarefaction or condensation as the inner cylinder is 
elevated or depressed. The air thus rarefied or com- 
pressed is conveyed to the patient through a large tube 
to an oro-nasal mask which fits hermetically over the 
nose and mouth, so that the patient breathes the air 
from the inner cylinder. A stop-cock attached to the 
mask controls the passage of the air. A manometer is 
attached to the inner cylinder to denote the pressure, 
and a water-gauge to the outer cylinder to indicate the 
water-level within. Finally, a graduated scale exists 
upon both cylinders, serving to measure the cubic con- 
tents of the air in either vessel. A spiggot at the bot- 
tom of the outer vessel permits the water to be drawn off. 

By means of this apparatus compressed or rarefied air 
can be inspired at will, on the one hand ; while, on the 
other, expiration can be made into rarefied or into com- 
pressed air, as may be desired. By a combination of 
two apparatuses, one act of respiration can be made in 
rarefied and the other in condensed air, or the reverse. 

If it is considered expedient to combine the inhalation 
of vapor of water or other vapors with the compressed 
air, as suggested by Hauke, von Cube, and others, it 
can be accomplished, as von Cube has done,* by inter- 
posing a Wolfe's bottle, suitably charged, between the 
tube leading from the apparatus and the oro-nasal mask. 

Domanski,t of Cracow, has proposed the inhalation 
of compressed air, charged with medicinal substances, in 
the treatment of bronchitis and phthisis. He recom- 
mends oil of turpentine, and also a one per cent, solution 
of carbolic acid. Such inhalations are said to be always 

* Berlin, klin. Woch., 1874, No. 4. 

f Berlin, klin. Woch., Jan. 4th, 1875; London Medical Record, 
Feb. 10th, 1875, p. 87. 



AIRS, GASES, VAPORS, AND FUMES. 47 

well borne, and not to irritate the larynx. Five pa- 
tients, who suffered from distressing cough and from 
copious expectoration, obtained immediate relief under 
this treatment. Also, in one case of phthisis, the vital 
capacity of the lungs is alleged to have increased from 
2850 to 3100 cubic centimetres, and in another case 
from 2100 to 2300 cubic centimetres. 

The bottle can also be used to contain a disinfectant, 
and thus disinfect the expired air of patients breathing 
into the apparatus ; another point of no small impor- 
tance when we consider the exposure to contagion, or at 
least contamination, to which patients are necessarily 
subjected, when an apparatus of this kind is used for 
one patient after another without cleansing. Separate 
mouth-pieces, for the same reasons, should be employed 
with certain patients. 

The amount of compression employed for therapeutic 
purposes is not very great. Waldenburg* begins with a 
pressure of one-sixtieth of an atmosphere, and gradually 
increases to one-fortieth, seldom exceeding this amount. 
In delicate subjects he begins with one-eightieth of an 
atmosphere pressure, and gradually increases it by ad- 
ditional weights on the internal reservoir of one pound 
after another. The inhalations are best accomplished in 
the erect position. One cylinderful generally suffices 
for from fifteen to twenty-five inspirations, according to 
the vital capacity of the patient ; but some will require 
from thirty to sixty inspirations to empty it, while 
others exhaust it in from ten to fifteen inspiratory ef- 
forts. Delicate persons consume from two to three cyl- 
inderfuls daily, with interruptions, and others from three 

* Op. cit., p. 138. 



48 THE INHALATION OF 

to six. Each sitting occupies from ten to thirty min- 
utes, inclusive of the periods of rest; and complete repose 
for fifteen minutes is recommended before and after the 
inhalation. The use of the apparatus is interdicted if 
the patient is overheated or somewhat exhausted from 
labor. The inhalations are usually taken once a day ; 
rarely twice. 

The entire pressure of the atmosphere on the inner 
cylinder of Waldenburg's apparatus equals about 1183 
pounds, or in round numbers 1200 pounds; and the 
weight of the inner cylinder itself is about 10 pounds. 
Dividing 1200 by the number representing the desired 
pressure, we obtain the number of pounds of weights 
required to be attached to the inner cylinder. Thus, if 
an additional pressure of one-eightieth of an atmosphere 
is wanted, 15 pounds would be placed upon the cylinder 
(from which we would deduct the weight of the cylinder 
itself) to press it down ; if the pressure is required to be 
reduced, a similar amount of 15 pounds would have to 
be hung upon the cords to draw it up (adding the weight 
of the cylinder, or 10 pounds additional); if we wanted 
to employ one-fortieth of an atmosphere, 30 pounds 
pressure, we would place 20 pounds on the cylinder for 
purposes of compression, or hang 40 pounds to the cords 
for purposes of rarefaction. 

For further details concerning the employment of this 
apparatus we refer those of our readers w T ho understand 
German to Waldenburg's recent volume, and those who 
cannot read German to a translation, in preparation, by 
Dr. Elsberg, of New York. 

Dr. Ph. Biedert,* of Worms, has constructed an ap- 

* Berliner klin. Woch. 1874, No. 29. 



AIRS, GASES, VAPORS, AND FUMES. 



49 



paratus (Fig. 12) on the principle of an acoustic bellows 
or harmonicum, to one end of which weights are affixed. 



Fig. 12. 




Beidert's Apparatus for Inhalation of Condensed and Rarefied Air. 

The whole apparatus rotates on a swivel at its centre, so 
that the bellows are compressed when the weights are 
atop, and dilated when they are at the bottom. Dr. 
Rose, of New York, who reports some personal use of 
this apparatus,* describes it as follows : 

" The bellows has the form of a cylinder, 50 centim- 
etres in height, 22 centimetres in diameter, which is 
closed at the ends by boards (a a') 1£ centimetres in 
thickness, termed covers. Its walls [b) are made of 
leather, air-tight, and have the necessary strength to 



* The Medical Record, 1ST. Y., Aug. 28th, 1875, p. 577. 



50 THE INHALATION OF 

maintain their ordinary form against overpressure of 
air. The lower cover has a perforation near its front 
margin into which a rubber tube (c) is fitted air-tight, 
and when in use is prevented from collapsing by a 
spiral wire which it contains. Straps are fastened cross- 
wise to the upper cover for holding weights ; pins being 
inserted which fit into holes in the weights and prevent 
their slipping. These weights are round plates of iron 
of the diameter of the covers of the bellows ; two are 
2h pounds each, and others 5 pounds each ; 30 pounds 
go with every apparatus. When the bellows is expanded 
as much as possible, it contains a column of air, the 
diameter of which is upon an average 2 centimetres less 
than that of the covers, on account of the zigzag outline 
of the walls of the bellows. The pressure which the 
covers of the bellows must support is equal to that upon 
a circular plane 20 centimetres in diameter, or 314 
square centimetres of area, which will be 648 pounds, 
taking 1033 grammes as the pressure upon a square 
centimetre. If the bellows is charged with 1 pound, 
the condensation of the air will be B \ E ; with 10 pounds 
it will be E \ ; with 20, ^ ; with 30, 2 y If the bel- 
lows is reversed, Aveights downward, and in this manner 
expanded, the cubic contents will be equal to the area of 
the cover multiplied by the height of the expanded bel- 
lows, 314 + 50 = 15,700 centimetres. 

" The other part of the apparatus is a stand of iron 
consisting of four opposite iron bars, two thinner (h) 
and two stronger (i), connected on top by a flat ring, the 
diameter of which is 24 centimetres. The lower ends' 
of the bars are fastened to the lower cover of the bel- 
lows, which can readily be removed. The upper cover 
of the bellows can be moved up and down, and is kept 



AIRS, GASES, VAPORS, AND FUMES. 51 

in line by guides running on the two upright thin bars 
of the stand. Guides are also attached to the body of 
the bellows, which slide on the two stronger upright 
bars. Small projecting pins (o) are attached to the 
centres of the larger bars, upon which the whole appa- 
ratus swings. These pinions are supported upon up- 
rights (p) from a firm base of wood (q). Upon the 
pinions the apparatus can be turned by two handles (r), 
one of which projects fron the ring above, the other at 
the lower end from one of the bars. This permits of a 
half turn of the apparatus backward. 

"The machine is placed upright on the margin of a 
table, so that the tube will lie in a groove cut into the 
wooden base, and the desired quantity of weights is fast- 
ened to the upper cover of the bellows. If the upper 
end is turned down, the weights will sink and the bel- 
lows will fill itself with air. The bellows is then turned 
back, while the patient compresses the rubber tube (e) 
with his fingers until he is ready to inhale through the 
mouth-piece attached ; he then gradually inhales the air 
as the weights compress the bellows. While the patient 
expires into the free air the bellows is filled again by 
turning, and the operation continued in this manner ad 
infinitum. For expiration into rarefied air the tube is 
compressed and the bellows turned weights downward ; 
applying the tube to the mouth the air passes from the 
lungs into the partial vacuum produced by the expansion 
of the bellows. The bellows filled with the expiratory 
air is emptied by turning, while the patient inspires air at 
the atmospheric pressure, and the operation repeated. 

"Finally, the patient can inhale condensed air from the 
partially filled bellows, and after turning the apparatus 
exhale directly into rarefied air." 



52 



THE INHALATION OF 



The main advantage of this apparatus is its compara- 
tively moderate price, which places it within the reach 
of patients for home use. The nature of its materials, 
wood and leather, renders it readily liable to become 
fouled by the emanations of the air breathed into it, and 
thus, under certain circumstances, to contaminate the air 
compressed for inspiration. 

Another cheap apparatus for home use is one recently 
devised by B. Friiukel, of Berlin. The accompanying 



Fig. 13. 




Frankel's Apparatus for Inhaling Condensed and Rarefied Air. 

illustration (Fig. 1 3) and the subjoined account, are taken 
from the article of Dr. Rose, already referred to. 

" As may be seen, it consists of the bellows of an ac- 
cordion. On one side a metal tube is inserted two centim- 
etres in diameter, which carries the mouth-piece; the 
latter may consist of an inflating rubber cushion, similar 
to a pessary. Frankel recommends the sitting position 



AIRS, GASES, VAPORS, AND FUMES. 53 

for using the apparatus. If the bellows is expanded by 
drawing the accordion apart, the air contained in it will 
be rarefied ; if it is compressed, the air is condensed. If 
the patient, during the expansion or compression, applies 
his mouth to the cushion the effect of the rarefaction or 
condensation of the air will communicate itself to the 
intrathoracic air. The apparatus is without valves ; as 
it is very easy to apply or withdraw the mouth from the* 
cushion at the right moment; any such arrangement as 
valves is therefore not necessary. If expiration is to be 
made into rarefied air, the mouth should be applied to 
the cushion and the bellows expanded. After the expi- 
ration the mouth is withdrawn from- the cushion, and 
while inhaling the free air the patient closes the bellows, 
for expiring the apparatus is found empty and ready. 

" All varieties of effects described with Biedert's ap- 
paratus can also be produced with Frankel's apparatus, 
by the patient himself, without assistance. He can 
either inspire condensed air only, or he can inspire con- 
densed air, and expire into rarefied air. 

" On the margin of the apparatus there is a centi- 
metrical measure, which plainly indicates by how many 
centimetres the wooden disks are separated or brought 
together. This shows the volume of air which has been 
drawn into or expelled from the apparatus. The appa- 
ratus is 35 centimetres in height, and 16 in breadth. If 
the foldings are considered, the bottom area will be 
15 X 34= 510 square centimetres. The expansion of 
the apparatus of one centimetre, according to the meas- 
ure affixed, would correspond with 510 centimetres of 
volume. 

" Frankel considers the attachment of the dynamom- 
eter to his apparatus as unnecessary. 



54 THE INHALATION OF 

" The air from this apparatus is more completely and 
more fully perceived by the lungs, and with less modi- 
fication of its original pressure than by any previous 
invention, due to the shortness of the breathing-tube. 
All excess of action is avoided, as it is worked by manual 
force only, Frankel having found that with his greatest 
efforts he could not condense the air above Jg of an 
atmosphere, nor the power of suction above ^ atmos- 
phere. 

" The patient is sensitive to the amount of pressure 
and draft upon his lungs, and can regulate both ac- 
cording to his own feelings. Frankel leaves this regula- 
tion to the patient, but warns him against overexertion. 

" The advantages of the apparatus are, that it is easily 
transportable and applicable anywhere (for inducing 
artificial respiration in cases of chloroform asphyxia, 
asphyxia of the new-born, poisoning by oxide of carbon, 
etc.). The apparatus is so cheap that the poorer patients 
can avail themselves of it and use it at home." 

It appears to me that too much manual exertion is 
required from the patient in the use of this apparatus, 
and that one so contrived as to be worked by the foot, 
would be less laborious. 

Hauke has invented two kinds of pneumatic cuirass 
to rarefy the air around the thorax, and thus effect its 
expansion in cases of insufficient inspiration, atelectasis, 
capillary bronchitis, and deformities due to collapse of 
the lung,* a result which his physiological experiments 
appear to promise. As yet there have been no results 
of the therapeutic application of the pneumatic cuirass 
published. 

* Wien. med.-Presse, 1874, 34 and 36 ; Centralblatt fur die med. 
Wiss., 1874, 58; London Medical Record, Jan. 20th, 1875, p. 38. 



AIRS, GASES, VAPORS, AND FUMES. 55 

Nearly ten years ago, acting on the hint that "insufflation of 
the lungs, by means of a pair of bellows, is said to have been of 
advantage in asthma,"* I made the attempt to administer inspi- 
rations of condensed air, first by means of a pair of kitchen bel- 
lows, and subsequently by means of a tube leading from a large 
reservoir, in which air was compressed by a condensing syringe, 
in fact by the large condenser used in my office in the production 
of sprays for medical purposes. Five minutes' pumping will pro- 
vide sufficient compressed air for half an hour's use; but the 
pressure is inconstant, and it is difficult to keep it uniform, even 
by continuous pumping ; and after a few trials I abandoned the 
attempt. Subsequently I endeavored to employ a large acoustic, 
bellows for the same purpose, but was unsuccessful in its use. 
Probably the want of sufficient data, of hospital material for experi- 
ment, and an indisposition to submit patients in private practice 
to treatment with which I was not familiar, deterred me from 
prosecuting experiments which might have eventuated success- 
fully. The recent publications of Waldenburg and others have 
induced me to study the subject anew, and secure one of Walden- 
burg's apparatuses, in the hope, ere long, of acquiring some sys- 
tematic personal knowledge in this interesting department of ther- 
apeutics. 

In the apparatus thus far described, the respirations of 
compressed or rarefied air are discontinuous or intermit- 
tent. Attempts have been made to provide for rythmic 
or normal inspiration of these airs, but they have not, 
thus far, been successful. A certain approach, however, 
seems to have been made by Prof. Stoerck, of Vienna, 
who has constructed an apparatus on a different princi- 
plef of compression. Instead of using direct pressure for 
the purpose of condensing the air, he employs a change 
of level in the water contained in two communicating 
reservoirs, by altering their position as they are swung 
backwards or forwards. A tin vessel is separated into 

* Wood's Practice, Philadelphia, 1858, p. 887. 

f Ein neuer Athmungs-Apparat, "Wien, 1874. Separatabdruck 
aus der "Wiener medizinischen Wochenschrift, Jahrgang, 1874. 
See also Nos. 5, 20, 24, 39, 40. 



56 



THE INHALATION OF 



two halves by a partition, with a slit for communication 
in its lower portion. The one side, the water reservoir, 
is open ; the other side, the air reservoir, is closed, save 
by an opening communicating by a tube to the face or 
mouth-piece ; and is further provided with a valve, to 



Fig. 14. 




Stoerck's Apparatus for Inhalation of Compressed and Rarefied Air 
(from Stoerck). 



permit the entrance of fresh air or the escape of the con- 
tained air. The apparatus is hung by prism-shaped 



AIRS, GASES, VAPORS, AND FUMES. 57 

supports upon an iron frame, in such manner as to 
swing easily back and forth when pushed by the hand ; 
the extent of swing, and thus the amount of pressure, 
being increased or diminished by raising or lowering 
the vessel, which is provided with a series of prisms at 
diiferent heights. The vessel being half filled with 
water is ready for use. When swung in such a man- 
ner that the air reservoir is lowermost, water enters into 
the latter from the water reservoir, and thus compresses 
the air which escapes through the tube connected with 
the mouth-piece ; and when swung in the reverse di- 
rection the water leaves the air reservoir, thus rarefy- 
ing its contents. The movements of the vessel can be 
regulated to correspond with the acts of respiration, and 
thus the inspiration of compressed air may be immedi- 
ately followed by expiration into rarefied air when the 
case requires it. 

Metallic apparatus, being more readily cleansed, are 
preferable, because expiration into these contrivances, 
even from healthy lungs, cannot fail to contaminate the in- 
terior of any apparatus, and eventually render it injurious. 

Treutler, of Blasewitz, has constructed an apparatus 
on the same principle.* It consists of two vessels com- 
municating by a tube, one of which is placed above the 
other. If now, water be allowed to flow from the up- 
per reservoir into the lower one, the air in the former is 
rarefied, and that in the lower one is condensed; and by 
reversing the position of the reservoirs, the air becomes 
reciprocally condensed and rarefied in the same manner, 
and so on ad infinitum. The same principle of hydro- 
static pressure was employed by Dr. Arnold, of Rox- 

* Wiener med. Woeh, No. 33, 1874; Walclenburg, q|>. cit. 
p. 183. 



58 THE INHALATION OF 

bury,* for producing a current of compressed air with 
which to operate the Bergson nebulizing apparatus. A 
number of other apparatus have been devised, but they 
are hardly worthy of separate mention. The interested 
reader is referred to the work of Waldenburg, already 
cited. 

Inspiration of compressed air increases the pressure on 
the lungs, and thus augments the vital capacity ; the chest 
becoming expanded to a greater extent than can be ac- 
complished by the most powerful voluntary inspiration of 
normal air. As a matter of course there is a consequent 
pressure exerted on all the organs in contact with the 
lungs, and on all the contents of the thorax. The ac- 
tion of the heart is increased and the pressure in the ar- 
teries augmented, so that the arterial walls are distended 
and the pulse becomes full and hard. The afflux of ve- 
nous blood to the right auricle is impeded, and the blood 
accumulates in the arterial system, the pulse becoming 
lowered in frequence a few (4-10) beats in the minute. 

Expiration into compressed air diminishes the quan- 
tity of expired air in proportion to the density of the 
compressed air. The interchange of gases is impeded, 
and if pushed to excess it will induce apnoea. It will 
strengthen the power of the auxilliaiy muscles of ex- 
piration. The effect oh the circulation is similar to that 
of the inspiration of compressed air, but in a greater 
proportionate degree. 

Inspiration of rarefied air diminishes the actual amount 
of air inspired, and if pushed to excess renders inspiration 
difficult, and produces apnoea. It strengthens the aux- 
illiary muscles of inspiration. Its action in the circu- 
lation is just the opposite of the effect of inspiration of 

* Boston Mod. and Surg. Jour., Dec. 27th, 1866, p. 434. 



AIRS, GASES, VAPORS, AND FUMES. 59 

condensed air. The intrathoracic pressure is dimin- 
ished, and its physical influence is exerted upon all the 
organs within the thorax. The heart's action is impeded 
and weakened, and the pressure in the arterial system 
diminished ; the pulse becomes soft, thin, compressible, 
and more frequent. The afflux of venous blood to the 
right auricle is facilitated, and blood accumulates in the 
pulmonary circulation, and diminishes in the general cir- 
culation. Pushed to excess, it may induce haemoptysis. 

Expiration into rarefied air increases the amount of air 
expelled from the lungs, and the lung contracts to a 
greater degree than it does under the most powerful 
effort of normal expiration. A greater proportion of car- 
bonic acid gas is therefore given off, and the succeeding 
inspiration is the more powerful and effective. It thus 
tends to decrease the volume of emphysematous lungs, 
and to increase the vital capacity of the lungs. The 
respiratory power is increased in both its acts. It af- 
fects the circulatory apparatus similarly to the inspira- 
tion of rarefied aii> but in a much less degree. The 
pressure is diminished in the arterial system, and the 
pulse becomes soft, compressible, small, and more fre- 
quent. Blood accumulates in the intrathoracic organs, 
and diminishes in the remaining portions of the body. 

It is thus apparent that in compressed and rarefied air 
we have powerful means of physically impressing the 
respiratory and circulatory systems, and thus of acting 
therapeutically upon them in diseases in which their 
functions are abnormally executed. 

Inspiration of compressed air is indicated in dyspnoea 
of almost every origin, in the chronic stages of pleurisy 
and emphysema, in atelectasis, in certain conditions of 
consumption, in bronchitis, asthma, emphysema, inflam- 
matory stenosis of the air-passages, asphyxia, insuffi- 



60 THE INHALATION OF 

ciency of the mitral valve, and in stenosis and insuffi- 
ciency of the aortic valves. 

Expiration into rarefied air is chiefly indicated in em- 
physema and bronchitis. 

Inspiration of rarefied air is indicated in cases of con- 
tracted thorax, as in predisposition to phthisis and its 
earlier stages, and in convalescence after pleurisy. 

Expiration into compressed air is indicated in cases of 
deficient normal expiration as a means of strengthening 
the expiratory muscles. 

The employment of compressed air is contraindicated 
in cases where the pressure in the aortic system is already 
great, and in cases of congestion or disposition to it in 
important organs outside of the thorax, in atheromatous 
degeneration of the arterial walls, in patients of apoplec- 
tic build, in hsematemesis, in menorrhagia, in bleeding 
haemorrhoids, and the like. Rarefied air is contraindi- 
cated in cases in which increased afflux of blood to the 
lungs is to be avoided, and in cases where the pressure 
in the aortic system is much diminished ; as in hemop- 
tysis and active inflammation of the pulmonary paren- 
chyma, and in weak heart. 

It has been proposed to localize the influence of con- 
densed air upon certain portions of the chest, when 
desirable, as upon the upper lobes of the lungs, for ex- 
ample, in incipient phthisis. For this purpose the lower 
portion of the chest is to be encircled with a bandage to 
prevent its expansion during the inhalation of the com- 
pressed air.* If it is desired to confine the action to one 
lung, as in cases -of pleuritic effusion, the patient is to lie 
upon the sound side so as to favor the entrance of the com- 
pressed air into the other side.f To localize the action 

* Waldenburg, op. cit., p. 345 

f (von Cube, Berlin, klin. Wocb., 1874, No. 12), ibid. 



AIRS, GASES, VAPORS, AND FUMES. 61 

upon the heart and the great vessels, the entire thorax 
is to be bandaged,* and so on. 

Deep inspirations, long held, will reduce the pressure 
in the aortic system ; and this can be increased by closing 
the mouth and nostrils during the process (Muller's ex- 
periment). This may be employed as a partial substitute 
for the inspiration of rarefied air. Expiration with closed 
mouth and nostrils increases the pressure upon the cir- 
culatory apparatus (Valsalva's experiment) ; and this 
can be increased by external pressure upon the chest and 
abdomen (Weber's experiment). This may be employed 
as a partial substitute for inspiration of condensed air. 
Expiration assisted by external compression upon the 
chest and abdomen (Gerhardt's method), f may be em- 
ployed as a partial substitute for expiration into rarefied 
air. 

The above hints are thrown out by Waldenburg, for 
utilization in cases in which there is an indication for 
their employment, in the absence of pneumatic apparatus. 

In this connection it may be remarked that forced 
respiration into the palm of the (left) hand, while the 
entire body is closely enveloped in a blanket, is an In- 
dian method of warding off influenza, tonsillitis, and the 
like.j 

Oxygen. 

Dr. Priestley, the discoverer of oxygen, suggested its 
use as a therapeutic agent ;§ but though utilized in that 

* (von Cube, Berlin, klin. Woch., 1874, No. 12), ibid., p. 345. 

f Waldenburg, op. cit., p. 319. 

X George Catlin ; Med. Times and Gaz., August 14th, 1869, p. 
210. 

$ Experiments and Observations on Different Kinds of Air (Lon- 
don, 1774). Birmingham, 1790. 

6 



62 THE INHALATION OF 

manner by Cailleus in 1783,* by Jurine in 1784,f 
Chaussier in 1785,t Chaptal in 1789,§and others, Bed- 
does appears to have been the first || to have made any 
sustained systematic attempt towards its therapeutic em- 
ployment. 

Although occasionally employed for remedial pur- 
poses, oxygen did not attract much favorable attention 
from the profession until some years after the publica- 
tion of Dr. Birch's volume, in 1857,1" m which the 
author claims the merit of " drawing professional atten- 
tion to a much neglected but highly important subject in 
therapeutics." 

Indeed, the rigorous investigations of Fourcroy, — 
who stated that in a number of cases of phthisis which 
he treated by oxygen, although the earlier symptoms 
were palliative, so much so in some instances as to 
promise approaching recovery, violent evidences of in- 
flammation ensued after a few weeks, apparently pre- 
cipitating the fatal termination,** — tended to deter others 
from its employment. Even Dr. Beddoes found it,f f in 



* (Gaz. de sante, 1783) ; Demarquay, Essai de pneumatalogie 
medicale, Paris, 1866, p. 577. 

f (Memoires de la soc. de med., 1789, t. x), ibid. 

% Ibid. I Ibid , p. 578. 

|| Observations on the Nature and Cure of Calculus, Sea Scurvy, 
etc. Bristol, 1792 ; London, 1793. 

Considerations on the Medicinal Use, and on the Production of 
Factitious Airs. Bristol, 1794, 1795, 1796. 

\ S. B. Birch, M.D., on the Action, Use, and Value of Oxy- 
gen in the Treatment of Various Diseases, etc. Second edition, 
London, 1868, preface. 

** Annales de chimie, 1790, No. 4; Demarquay, op. cit , p. 597. 

ff Louis on Phthisis, Cowan's Translation, Washington, 1836, 
p. 288. 



AIRS, GASES, VAPORS, AND FUMES. 63 

his own person, to occasion true hectic, emaciation, dry 
cough, and dyspnoea. 

Fourcroy, however, " had witnessed good effects from 
inhalations of oxygen in the chlorosis of young girls, in 
the scrofulous affections of children, in humid and 
chronic asthma, in abdominal obstructions, in hypo- 
chondria, in commencing rachitis, and in those obstinate 
dyspepsias accompanied by pallor of the skin and gen- 
eral debility. Its advantageous effects, in these affec- 
tions, are manifested by very manifest augmentation of 
the heat of the skin, the appearance of color in the face, 
and acceleration of the pulse ; these symptoms increas- 
ing, so that at the end of some weeks a veritable febrile 
movement results, and a general augmentation in the 
activity of the solids, the influence of which in the cure 
of chronic affections is no longer a problem for phys- 
icians accustomed to meditate on the march of nature in 
the spontaneous cure of many of these maladies."* 

The most interesting and exhaustive account of the 
therapeutic uses of this agent is from the pen of Demar- 
quay,f who presents a detailed study of its medical his- 
tory, its physiologic action, and its therapeutic appli- 
cations in the practice of medicine and of surgery. In 
opposing the views of those who believe the inhalation 
of oxygen to be dangerous, on account of its activity in 
chemical combustion, Demarquay states'! that he himself, 
his friends, his pupils, and large numbers of his patients 
have inhaled from ten to thirty litres§ of the gas at a 
time without experiencing the slightest injury. With 
certain exceptions and variations dependent upon the 

* Demarquay, op. cit., p. 599. 

f Essai de pneumatologie medicale, Paris, 1866, pp. 554-822. 

| Op. cit., p. 668. I A litre equals 1.0567 quarts. 



64 THE INHALATION OF 

idiosyncrasy of the subject or his state of health, the first 
inhalations of oxygen, writes Demarquay, produce some- 
times a slight sensation of heat in the mouth, which is 
propagated to the larynx and the interior of the chest. 
This heat is rapidly communicated to the hypogastrium, 
but generally disappears a few moments after the inha- 
lation of oxygen has ceased. The pulse is usually accel- 
erated at the same time, and may increase from four to 
twenty pulsations, and even more, in the minute. The 
pulse also becomes hard, but this phenomenon is not of 
long duration. In some cases the pulse remains nor- 
mal, or is even slightly retarded; but the most common 
phenomenon is the hardness it acquires. Many persons 
experience a sense of heat in the skin, and a disposition 
to moisture. The effect on the various sensations is but 
slightly marked, except in nervous subjects. In many 
instances a desire for muscular activity is developed. 

The appetite is generally excited by these inhalations. 
Most of the patients to whom Demarquay administered 
oxygen experienced this result within a few days. He 
was unable to determine anything positive with regard 
to the other functions of the economy, especially as re- 
gards the secretions. 

Some experiments performed upon himself by Dr. 
Andrew H. Smith, of New York,* developed the re- 
markable fact that the inhalation of a considerable quan- 
tity (400 to 1200 cubic inches) is followed by a tempo- 
rary decrease in the amount of carbonic acid exhaled ; 
but, notwithstanding this temporary decrease, Dr. Smith 
is of the opinion that the ultimate effect of oxygen is to 
cause its slight increase. Experiments of Dr. Smith as 

* Oxygen Gas as a Remedy in Disease, New York, 1870, p. 22. 



AIRS, GASES, VAPORS, AND FUMES. 65 

to the effect of oxygen on the excretion of urea indicate 
that it causes a decrease in the amount of urea formed. 
The quantity of uric acid in the urine appears to be 
rapidly diminished by the daily use of oxygen.* Koll- 
rnannf and Eckard conclude from this fact that oxygen 
may be administered as a remedy in acute gout. 

Demarquay refers much of the objectionable results, 
formerly attributed to inhalations of oxygen, to certain 
impurities with which it became contaminated in the 
methods of preparation ; an objection to its use which 
no longer exists under the improved methods of obtain- 
ing the gas in its pure state, for details of which the 
reader is referred to the standard works on chemistry. 

Oxygen is indicated in ansemia and many of the af- 
fections with which it is associated, such as chlorosis 
and dyspepsia. Asthma is the affection for which it is 
most frequently prescribed. It often terminates the 
paroxysm, though it does not cure the disease. In acute 
phthisis with fever, it is contraindicated on the ground 
that superexcitation of the nervous or circulatory sys- 
tem is injurious. But in the earlier stages," associated 
with dyspepsia and impaired appetite, its effects are bene- 
ficial. It has been of service, also, in dilatation of the 
bronchi, in chlorosis, and in many cases of cephalalgia. 
These are the views of Demarquay, who presents them 
in detail, supported by the recital of many cases. 

Among others he cites a remarkable case of ganglionary enlarge- 
ments of the axilla, the neck, along the trachea, and probably along 
the bronchi, which had been sent to him with a view to trache- 
otomy, and in which, under the influence of oxygen, the condition 

* Smith, op. cit., p. 24. 

f Miinchener Arztl. Int-Bl., 1869 ; Waldenburg, op. cit., p. 697. 



66 THE INHALATION OF 

underwent prompt amelioration, so that the operation became un- 
necessary, and the patient was able to resume her usual avocation. 

He also thinks it will be found of service in typhoid 
and intermittent fevers, and in neuralgia, paralysis, and 
other affections of the nervous system. 

Demarquay, as the result of his extensive clinical ex- 
perience, recommends inhalations of oxygen in all chronic 
affections associated with debility, dyspepsia, and anaemia; 
the enumeration of which it is needless to repeat. In 
most of this experience, however, oxygen was not admin- 
istered as the direct curative agent, but as part of sys- 
tematic treatment, for its use in surcharging the tissues 
with oxygen, and facilitating the combustion of the ele- 
ments of excretion. On this same general principle De- 
marquay was led to employ inhalations of oxygen in the 
treatment of surgical affections.* Both in the prepara- 
tion of debilitated patients to undergo serious operations, 
and in the treatment of protracted suppuration and other 
depressing conditions after operation, inhalations of oxy- 
gen were found of great efficacy. A number of cases 
in point, of the most varying character, are detailed in 
the Medical Pneumatology of Demarquay. 

It has been maintained by Lange, Pravaz, Demar- 
quay^ and others, that the beneficial effects of compressed 
air-baths are due to the greater supply of oxygen which 
is presented to the body for absorption. In many re- 
spects the sensation experienced under the two condi- 
tions are analagous ; but it is evident, upon reflection, 

* The local application of oxygen to wounds, etc , does not come 
under our theme; and for details on this subject, the reader is 
referred to the essay of Demarquay, so often cited, and to other 
essays on oxygen gas. 

f Op. cit., pp. 673-680. 



AIRS, GASES, VAPORS, AND FUMES. 67 

that the free access of a gas to the part cannot exercise 
that physical influence of compression or condensation 
to which so much of the benefit of compressed air is at- 
tributable. There may be a similarity, doubtless, in the 
chemical effects upon the blood of compressed air and of 
oxygen, even though their action be not identical ; and 
the secondary results of these effects may then, of course, 
be the same in either instance. The physical impres- 
sion upon the respiratory surfaces, however, is different, 
and in so far as the physical influence for compressed 
air is indicated as a restorative measure, facilitating 
the resumption of impaired function, it is not fulfilled 
by the simple inhalation of free or combined oxygen. 

The inhalation of oxygen in the narcosis from chloro- 
form, carbonic acid, opium, and the like has received 
commendation from several reliable sources. 

Thus, under the impression that the specific effects of 
ether vapor upon the system are due to its power of pro- 
ducing a state analagous to asphyxia, it has been sug- 
gested by Dr. Jackson, and subsequently by Mr. Eich- 
ardson,* that oxygen should be kept ready to be inhaled 
in case of the occurrence of formidable symptoms ; and 
Mr. Hooper, acting on the suggestion, has supplied his 
inhaler with the means of furnishing oxygen at pleasure. 
" Ducroy has stated in the Parisian Academy of Science, f 
that pure oxygen, contrary to the general belief, can be 
inhaled for several hours without being detrimental to 
health ; that its action is antagonistic to that of chloro- 
form ; that it is a powerful remedy for the disagreeable 
accidents arising from chloroform and other anaesthetics ; 

* Banking's Abstract, vol. 5, 1847, p. 332. 

f Juno, 1850; Arch. gen. ; also, Beigel on Inhalation, London, 
1806, p. 72. 



6S THE INHALATION OF 

and that in asphyxia from poisonous gases — as, for in- 
stance, from carbonic acid — it exercises likewise a bene- 
ficial influence. Ducroy, therefore, proposed to make 
every patient, awakening from a chloroform-narcosis, 
inhale oxygen, in order to rid him of headache and other 
inconveniences following the administration of that an- 
esthetic. According to the reports of different authors, 
it should be a rule, whenever chloroform is administered 
to have the oxygen-inhaler ready for use." 

Mr. Erichsen, in his Monograph on Asphyxia says : 
"In a considerable number of experiments that I have 
performed on this subject, I have never succeeded in re- 
exciting the contractions of the ventricles by means of 
the inflation of the lungs with common air, provided 
they had fairly ceased to act before artificial respiration 
was set up." He was then led to try oxygen, and in 
several instances was successful in restoring the action of 
the ventricles after the entire cessation of the heart's 
action.* 

The following case is relatedf in support of the idea 
that the inhalation of oxygen might be very beneficial 
in the asphyxia caused by chloroform and carbonic acid, 
or by drowning : 

" A young man attached to the laboratory of the New York 
Medical College," writes the late Dr. Simeon Abrahams, "became 
asphyxiated from the inhalation of the vapor of chloroform : and 
so far had its effects been carried, that he became pulseless, and 
all hopes of his resuscitation abandoned ; and as all the usually 
recommended remedies had been tried without success, nothing 
but the death of the young man was looked for, when I proposed, 
as a dernier ressort, the application of pure oxygen gas as the only 

* Beigel op. cit., p. 73. 

f Ranking's Abstract, vol. 17, p. 118, from the Canada Medical 
Journal, Jan. 1853. 



AIRS, GASES, VAPORS, AND FUMES. 69 

chance by which resuscitation could be brought about ; but, at 
the time, the proposal met with opposition from the medical men 
present, who were anxiously watching what seemed to be the ex- 
piring efforts of the poor boy, expecting each moment to be his 
last. Having, however, consented, the gas had not been more 
than a few seconds applied to his nostrils, when he who was appa- 
rently beyond the help of human aid, and absolutely in articulo 
mortis, arose and placed himself upon a chair, proving most con- 
clusively how correct I was in proposing the application of oxygen 
gas as a remedy against the deleterious effects of chloroform as an 
anaesthetic." 

Dr. Const. Paul,* reports a case in which the gas was 
successfully used in a case of opium poisoning, after 
atropia had failed, and when the patient appeared to be 
dying ; and another, in which it was successfully em- 
ployed in narcosis from charcoal gas. 

Two cases of restoration by oxygen in poisoning by 
carbon are reported by Sieveking,t and one, a curious 
case, by Linas.J 

Inhalation of oxygen has been employed with more 
or less success in cholera. Thus it was used with suc- 
cess by De Smyttere, in the epidemic of 1832 ;§ and in 
the Reports on Asiatic Cholera in the Madras Army 
from 1828 to 1844,|| it is spoken of favorably. So, also, 
favorable cases have been reported by Macree, in India, 
in 1850, and Harvey, in London, in 1853 ;^[ while 
Schwarz, in 1831,** Foy, in Poland, 1831, andHutin, in 



* Bull, gen ther., t. lxxv, Aug. loth, 1868; Allg. med. Cent. 
Ztg., 1868, p 939 ; Banking's Abstract xlviii, 1869, p. 117. 

f The Lancet, 1869. 

% Bull, de therap., June, 1869, p. 519; Gas. med., Paris, 1869, 
No. 18, p. 245. 

\ Smith, op. cit., p. 32 

|| By Samuel Kodgers, London, 1848. 

\ Smith, op. cit. ** Waldenburg, op. cit., p. 696. 



70 THE INHALATION OF 

Africa, 1835,* employed oxygen without any beneficial 
results. 

Coming more closely to the present decade we find 
that Dr. Wittmeyer,t of Nordhausen, has suggested the 
inhalation of oxygen, and of the vapor of water in the 
stage of asphyxia in cholera. He is led to the employ- 
ment of these inhalations because the functional activ- 
ity and absorbent powers of the alimentary canal being 
impaired, and hypodermic injection having failed, there 
remains open to us but the respiratory tract by which to 
convey remedies to the system at large. He considers 
two indications highly important in this stage of cholera ; 
the first being to convey water to the thickened blood ; 
for which purpose he proposes that the patient shall 
inhale steam and hot water nebulized from one of 
Seigle's apparatus, the temperature of the nebulized 
water being kept sufficiently warm by a flame under 
the medicine-glass ; then, he contends that as the thick- 
ening of the blood impedes the interchange of the gases in 
the lungs, the second indication is to convey oxygen to 
the blood, which is best accomplished by inhalation of 
the pure gas, which he maintains would have a more 
promptly excitant action upon the heart than any ordi- 
nary medicine which could be administered in another 
method ; and as a result, the blood would be enabled to 
circulate through the vessels more rapidly, and become 
better and better prepared to imbibe the desired amount 
of vapor of water and of oxygen. 

Dr. Jiitte, of Stettin, commenting^ on the article of 
Dr. Wittmeyer, says that he had made the experiment 

* Smith, op. cit. 

f Deutsche Klinik, Oct. 13th, 1866, p 366. 

+ Ibid, Dec. 1st, 1866, p. 436. 



AIRS, GASES, VAPORS, AND FUMES. 71 

of administering oxygen by inhalation to four adult 
patients during the short and severe epidemic which 
prevailed in and about Stettin in the year 1856; and 
that the administration had been conducted with great 
care, and with sufficient frequency ; but that all of his 
patients died without evincing the least sign of even 
temporary improvement, and he was so disappointed 
with the result that he did not pursue the experiment 
any further. 

This idea of Dr. Wittmeyer is not new, as far as 
regards oxygen inhalations in cholera; though, as far as 
I know, the suggestion of the inhalation of the vapor 
of water under such circumstances, is entirely original. 

As early as 1794, oxygen had been employed in 
croup ;* and Bretonneau reported to the Parisian Acad- 
emy of Medicine, in 1821, good effects in a case of 
croup in which it w T as sought to prolong life by means 
of oxygen until calomel could have time to act ; and 
although it failed, he was of the opinion that it might 
have been of more avail under more favorable circum- 
stances.f 

BeigelJ considers the administration of the gas indi- 
cated in the suffocative paroxysms of croup to guard the 
patient from the consequences of such attacks, which 
frequently prove fatal, and to place him in such a posi- 
tion as to enable us to apply other remedies ; oxygen, 
under such circumstances, having in some measure the 
same effect as tracheotomy, whereby we intend to evade 
a particular part of the respiratory tract, in order to gain 

* Baillie, Med.-Chir. Trans., 1815, p. 136. 

f Second Memoir, Sydenham Society's Memoirs on Diphtheria, 
London, 1859, p. 51. 
J Op. cit., p. 104. 



72 THE INHALATION OF 

time till we possibly master the inflammation, as well as 
the formation of the pathological products represented 
by the croupal membranes. 

As an illustration of this fact, Dr. Beigel reproduces 
the following case, reported by Miquel :* 

" Severe case of croup; application of the usual medicaments 
without benefit. Immediate alleviation after oxygen had been in- 
haled. — The patient was a boy twenty-one months old, hitherto 
perfectly healthy. On February 21st, 1862, Miquel was summoned, 
and found the child in the following condition : Breathing, noisy 
and whistling, short, some fifty respirations in the minute, but ir- 
regular, as well in respect to the ryhthm as to duration ; pulse small, 
very frequent, impossible to be counted ; countenance pale, lips 
livid ; all muscles are active during breathing, and the regular 
movements of the levatores alas nasi, of the muscles of the throat, 
etc., were combined with irregular spasmodic movements, which 
now and then agitated the face. The little patient frequently bent 
his head quite backwards, the expression of his countenance being 
very anxious, and seized his throat convulsively with his hands. 
His face was moist and cold The child very seldom yet made 
efforts to cough ; when coughing, the voice appeared barking, 
hoarse, suppressed. According to the report of the house doctor, 
nine days ago the child was seized with symptoms of croup, which 
at first decreased by emetics, leeches, and other remedies, but 
three days ago have recurred with great intensity. The usual 
remedies were applied again, but failed to do any good, and a 
newly administered emetic was to the same effect ; involution of 
the legs in mustard powder, and inhalations of hot steam, were 
vainly resorted to. At half-past ten, inhalations of oxygen were 
tried. One cubic foot of that gas, one volume of pure oxygen 
mixed with a smaller portion of atmospheric air in a gasometer, 
was brought to the patient's residence. The amount of respiration 
might have been about five cubic inches, the quantity of gas (1728 
cubic inches) was, therefore, sufficient for 850 inspirations, which 
might have been performed in about nine or ten minutes, yet the 
procedure lasted about fifteen to twenty minutes. The child's 

* Correspondence-Blatt des Vereins fur gemeinschaftliche Ar- 
beiter, 1862. 



AIRS, GASES, VAPORS, AND FUMES. 73 

condition after the inhalation was the following : pulse percepti- 
ble, less frequent, number of respirations about the same. The 
appearance of the child was, according to the judgment of all 
persons around him, more quiet, less anxious; patient became 
more reactive to the impediment to respiration, so that he coughs 
frequently, though with the peculiar croup sound ; once such a 
cough spontaneously produced vomiting. The spasmodic move- 
ments of the muscles of the face, as well as of other regions of the 
body, ceased, and at one o'clock in the morning the parents came 
to me to report that the child had slept very quietly, and that the 
spasm and anxiety had disappeared. They added that on no pre- 
vious night the suffocating seizures and the expression of the 
countenance were so alarming ; but that on none of the four pre- 
vious nights was the patient so quiet as he is to-night. On the 
following morning the child was found to be still better, and 
though the oppression recurred on the following evening in a 
slight degree, yet all the remainder vanished by medicaments 
applied for the disease itself, and the patient recovered entirely." 

Beigel relates the details of several cases under his 
own care, treated by alternate inhalations of oxygen and 
of nebulized fluids. 

One of these' 54 ' was advanced diphtheria in a child six years of 
age, which was cured by the inhalation of oxygen gas, one gallon 
morning and evening, and the inhalation of a solution of the 
tincture of the chloride of iron, ten minims to the fluid ounce of 
water ; a remarkable alteration in the patient's condition being 
perceptible after the first inhalation of oxygen. Alsof a very 
severe case of diphtheria after small-pox, with exudation lining 
the whole phai^nx, laryngeal implication, suffocative paroxysms, 
etc. The patient, a boy ten years of age, was seen by Dr Beigel 
on the fourteenth day of the illness, after the administration of 
calomel for six days had afforded no relief. This case was treated 
bj 7 inhalations of the spray of hut water, afterwards of lime-water, 
and subsequently of tannin ; oxygen being administered to relieve 
the suffocative attack with complete success, and being continued 
twice a day as long as requisite ; the combined treatment resulting 
in a cure. 

* Op. cit , p. 114. f Op. cit., p. 116. 



74 THE INHALATION OF 

Dr. Andrew H. Smith* states it as his " firm convic- 
tion that oxygen will do in croup all that can be done 
by tracheotomy/' though " neither the one nor the other 
is competent to undo the mischief wrought by severe 
and prostrated dyspnoea." It is hardly necessary to say 
that this opinion is not indorsed. The author has else- 
wheref expressed the opinion that in croup atmospheric 
air is wanted and not oxygen, and that if the glottis 
be too obstructed to admit of a proper supply, a larger 
aperture should be made artificially for the purpose, for 
oxygen cannot be a substitute for tracheotomy as long as 
the calibre of the glottis is diminished by swelling or 
false membrane. Still it must be borne in mind that 
some experiments instituted and described by Dr. B. W. 
Richardson, of London, { led him to the belief that the 
retention of carbonic acid gas favored the fibrination of 
the exudation ; so that oxygen may possibly counteract 
the effect of the carbonic acid gas, and keep the exuda- 
tion diffluent. So many cases in which tracheotomy is 
indicated, terminate favorably without it, that it is im- 
possible to place a correct estimate upon the value of any 
legitimate remedy, the administration of which is fol- 
lowed by recovery. 

Beigel believes that in children predisposed to phthi- 
sis, the inhalation of oxygen gas would delay, or even 
prevent the outbreak of the disease ; and that even after 
the development of the affection, inhalations of oxygen 
gas sometimes render astonishing services. 

In proof of this he details a case$ in which an engineer, twenty- 

* Op. cit., p. 28. 

f Diseases of the Throat, New York, 1872, p. 405. 

% The Lancet, Sept. 24th, 1870, p. 438. 

\ Op. cit., p. 182. 



AIRS, GASES, VAPORS, AND FUMES. 75 

three years of age, of scrofulous diathesis, with tuberculous infil- 
tration of the left apex, and bronchial catarrh of the right lung, 
with haemoptysis, colliquative perspirations, and rapid loss of flesh, 
was so much improved by the inhalation of a gallon of oxygen 
twi(je a da} 7 , and of a solution. of the sesquichloride of iron twice a 
day, that in a little less than five months, at which time the treat- 
ment was discontinued, the patient could hardly be recognized as 
the same man ; he had grown strong and muscular, and hut that 
dulness remained at the left apex, he could be considered perfectly 
healthy. He was seen a year afterwards by Dr. Beigel, whom he 
assured that he had enjoyed very good health during the whole of 
that period. 

My personal experience with oxygen gas as a thera- 
peutic agent has been, comparatively limited, chiefly 
because I have not found it as valuable an agent in my 
own hands as it appears to have been in the hands of 
others. I have employed oxygen in a number of cases 
of imperfect aeration of the air-cells of the lungs from 
deficient inspiration, and with decided benefit ; but I 
am not prepared to state the benefit was not entirely 
due, — as it was in great measure due, certainly, — to the 
mechanical effect of the inhalation expanding the air- 
cells by forced inspiration; for in the fine weather of 
spring and summer I have seen results fully as satisfac- 
tory from regular deep inspirations of fresh air : the 
patient seated in the open atmosphere, or before an open 
window, and taking deep inspirations slowly, while an 
attendant forces the shoulders backwards so as to assist 
the expansion of the chest during the effort of inspira- 
tion. From four to eight such efforts are sufficient at 
a time to begin with, and may be repeated twice a day. 
In cases where there is a sense of oppression in the upper 
portions of the chest from inefficient expansion, the re- 
lief given by these movements is prompt and decisive. 

I feel free to record that in one case of undoubted incipient 



76 THE INHALATION OF 

phthisis, — by which I mean a case of impaired respiration, in 
which the general symptoms and the family history strongly 
pointed to the onset of pulmonary tuberculosis, but in which 
there were as yet no positive physical signs of the disease other 
than impaired respiration, and extreme dyspnoea, at the first insti- 
tution of the mechanical exercises above mentioned, — the inha- 
lation of oxygen gas certainly warded off the threatened disease, 
and gave the patient renewed vigor, as evinced by increase in 
nutrition, renewal of vital buoyancy, and restored powers of 
physical endurance. Of course, it is impossible to say determin- 
ately that this case would have been one of phthisis ; for when any 
threatened disease is early arrested, or aborted, the pathological 
evidences of correct diagnosis are lost. This patient, treated in 
1866, remained in fair health for a number of years; but of his 
subsequent history I know nothing. 

After faithfully trying oxygen in many cases of con- 
firmed phthisis, I am not disposed to regard it with any 
special favor. In some of my cases it afforded consider- 
able temporary relief to dyspnoea, but I do .not really 
believe that life was prolonged in any instance by its 
agency. The idea of breathing a " purified air " is 
greedily entertained by patients who insist that " they 
would get right well, if they could only breathe better," 
and in this way the occupation afforded to the mind for 
a few days actually effects an improvement in the gen- 
eral condition for the time, in some instances. The 
improvement, unfortunately, is transitory ; and I can 
hardly recall a patient who did not soon become indif- 
ferent to the inhalation of oxygen, or in whose case the 
oxygen was not abandoned, sooner or later, without any 
regrets, save for the disappointment. Still I have seen 
considerable comfort follow the institution of the treat- 
ment, whether emotional or physical I am unable to 
determine; and this sense of satisfaction sometimes re- 
mains until it is apparent that the oxygen is incompetent 
to cure the disease ; and, therefore, oxygen may be legiti- 



AIRS, GASES, VAPORS, AND FUMES. 77 

mately resorted to upon suitable occasions. Despite the 
contempt expressed for the opinion, I believe that the pro- 
longed use of oxygen burns the patient up, in some in- 
stances, or in other words, consumes him the faster ; and 
this is the more evident if it is impracticable to supply 
by nutriment the waste of tissues subjected to super- 
oxygenation. There is a time, in tuberculous phthisis 
especially, when oxygen will no longer palliate, relieve, 
or stimulate; and the decline, as was recognized by 
Fourcroy, seems really more precipitate in consequence 
of the previous employment of this powerful agent for 
good or evil. 

So much has been claimed, however, for the thera- 
peutic uses of oxygen inhalations, that I have deemed it 
a duty to present a fair representation of the records in 
its favor. 

Almost all writers on oxygen extol its use in anaemia, 
chlorosis, asthenia, asthma, emphysema, and the pretu- 
berculous stage of phthisis. But it is said to have still 
further uses. Of its employment in cholera and in 
croup mention has already been made. It has also been 
used in diphtheria. Dr. Francis* used it with advan- 
tage in a case of malignant scarlatina with diphtheritic 
exudation in the throat, and believed it to have assisted 
in sustaining life during the remedial action of other 
agents. It has been used with more or less success in 
the treatment of many constitutional diseases ; diabetes,f 



* The Lancet, March, 1858. 

f Birch, Brit. Med. Jour., December 24th and 31st, 1859, and 
op. cit., ]>. 105; Bouchardat (Rev. med., 1857), Arch. f. klin. 
Med., 1870, p. 51 ; (Berenger-Feraud and Yvan), Demarquay, 
op. cit., p. 710. 



78 THE INHALATION OF 

albuminuria,* syphilis,"}" scrofula,! scorbutus,! gout,|| 
boils and carbuncles,Tf torpid and gangrenous ulcers,** 
neuralgias,*}" f epilepsy, J J paralysis,§§ atonic and fatty dis- 
eases of the heart,|||| dyspepsia in valvular cardiac dis- 
ease,^ and also in pneumonia,*** capillary bron- 
chitis,ttt an( ^ some other acute affections. 

The gas is occasionally administered pure, but more 
frequently mingled with from one to ten or more parts 
of atmospheric air, and to the amount of from one to 
ten gallons once or twice a day. The atmosphere may 
be roughly impregnated with oxygen extemporaneously 
by throwing a quantity of chlorate of potassa upon live 
coals, but of course this method is much inferior to one by 
which the gas can be collected in a reservoir. Oxygen 
may be inhaled from a simple reservoir, gasometer, or 
gas-bag, or from cylinders into which it has been com- 
pressed. The latter is the preferable plan ; and it is 
advisable, as recommended by Demarquay, to allow the 
gas to pass through a wash-bottle before reaching the 
tube to which the mouth-piece is attached. 

* Casorati (Gaz. Lombard, 1852, No. 19) Waldenburg, op. cit., 
p. 697; Prof. Mackcy, Practitioner, May, 18G9, p. 276 ; Smith, op. 
cit., p. 47. 

f Birch, op. cit. % Beddoes. $ Ibidem. 

|| (Kollman and Eckardt) Waldenburg, op. cit., p. 698 ; Golden, 
the Lancet, March 10th, 1866. 

^[ Birch, op. cit., p. 74. ** Hill; Thornton; Demarquay. 

ff Hooper; Birch; Demarquay. 

XX Beddoes; Birch; Eamskill, Med. Times and Gazette, July, 
1863. 

\\ Beddoes; Birch; Tannin-Despalle (Gaz. med., Paris, 1875, 
p. 229) ; Practitioner, July, 1875, p. 60. 

Illl Birch. \\ Smith, op. cit., p. 31. 

*** Golden, Lancet, March 10th, 1866; Smith, op cit., p. 29; 
George H. Butler, New York Med. Jour., November, 1869, p. 149. 

fff Smith, op. cit., p. 30. 



AIRS, GASES, VAPORS, AND FUMES. 79 

Ozone. 

Inhalations of ozone have been recommended in 
cholera by Stiemer,* and by Scelles in diabetes and 
gout.f The principal advocate of ozone is Lender, J 
who not only recommends it in all cases in which 
oxygen is indicated, but also in the entire series of septic 
diseases, in the list of which he includes many affections 
that are not at all regarded as infectious ; so that, as 
Waldenburg remarks, the entire subject has been more 
injured than benefited by the great extent of his re- 
searches. 

Ozonic ether has been administered by inhalation in 
phthisis ; and this method has been considered prefer- 
able to its administration by the stomach. 

Lender proposed its inhalation from the so-called 
ozonized water, introduced into a Wolfe's bottle or 
ordinary inhaler; but it is a matter of doubt among 
chemists whether this water contains any ozone at all. 

Ozone for inhalation is, perhaps, best prepared by the 
action of strong sulphuric acid on the bichromate or the 
permanganate of potassa. Bottger§ mixed very gradu- 
ally three parts of the acid with two of the latter salt, 
and he states that this mixture will continue to give off 
ozone for several months. It has been prepared in 
various ways for chemical and physiological experiment, 

* (Die Cholera, etc., Konigsberg, 1858); Waldenburg, op. cit.,p. 
709. 

f (Acad, de med. de Paris, June 27th, 1875), ibid. 

% (SauerstoiF und Ozon-sauerstoff, Berlin, 1870 ; various arti- 
cles in the Berliner klinische Wocbenschrift for 1871, and in the 
Deutsche Klinik for 1870, 1871, and 1872), ibidem, p. 708. 

g (Zeitschr. f. Chem. und Pharm., Bd. iii, p. 718) ; Fox, Ozone 
and Antozone, London, 1873, p. 25. 



80 THE INHALATION OF 

for an account of which the reader is referred to the 
work of Dr. Fox. 

Nitrous-oxide. 

The inhalation of nitrous-oxide (laughing-gas) has 
been employed pure, for the purpose of supplying the 
system with a large amount of the oxygen it contains, 
and in the same affections for which oxygen has been 
recommended, such as anaemia, incipient phthisis, and 
the like. It is now prepared extensively in all our 
large cities as an anaesthetic for dental purposes, and 
can thus be readily procured by those who wish to try 
its efficacy. 

Beddoes employed it with benefit in paralysis,* and 
Sir Humphrey Davyf inhaled it three times a day for 
periods of one week and two months respectively, and 
found it of great benefit to his general health. He 
experienced a surexcitation of all the organs of sense, 
as evinced by more distinct and lively sensations than 
were common. 

RiadoreJ employed it with success in a number of 
cases, principally affections of the nervous system. 

Surgeon George G. Shumman, United States Volun- 
teers, has reported§ a number of cases (fourteen) of typhoid 
fever, also two of measles, and one of erysipelas, in which 
inhalations of the nitrous-oxide gas were administered 
at the stage of prostration for the purpose of supplying 
oxygen to the system, with beneficial results in all cases ; 

* Sir H. Davy, Researches, etc., chiefly concerning Nitrous- 
oxide, 1800, p. 542. 

f Op. cit. 

J On the Remedial Influence of Oxygen, Nitrous-oxide, etc., 
London, 1853. 

I Am. Med. Times, 1863, pp 28 and 38. 



AIRS, GASES, VAPORS, AND FUMES. 81 

even in some which proved fatal, for life had been ap- 
parently prolonged many hours by this means, although 
insufficient to stimulate to the point of recuperation. 
Some of these cases which recovered, had been pro- 
nounced hopeless, and all of the patients are reported 
as having expressed themselves as feeling much the 
better for the inhalations. Attention is called to the 
resort to this method in the prostrated stages of cholera 
and other affections. 

Whether it acts by supplying oxygen is an open 
question. Other compounds of oxygen and nitrogen 
containing a much larger proportion of oxygen, are, as 
is well known, extremely deleterious when inhaled. 
It is quite probable that the nitrous-oxide has an influ- 
ence of its own ; because we know that the action of 
chemical compounds is often different to what might be 
inferred from a knowledge of the effects of their con- 
stituents. 

Dr. C. W. Larison* has reported a case of recovery 
in miliary tuberculosis under inhalations of five gallons 
of the gas a day, at intervals. 

Nitrous Acid. 

Dr. Thomas recordsf a case of hooping-cough of 
nearly three weeks 7 duration, which was cured within 
ten days by the inhalation of nitrous gas : 

The patient was his own son, aged between four and five 
months, and he was led to the use of the remedy from the perusal 
of some cases treated by this gas by Mr. Patterson, in J. Car- 
michael Smith's work on Nitrous Vapor, to which his attention 
was called for the purpose by a professional friend. He closed 

* Cincinnati Med. News, November, 1874. 
f Am. Med. Recorder, 1822, p. 660. 



82 THE INHALATION OF 

every aperture of the apartment occupied by the little patient, 
which might afford exit to the gas ; he then placed a teacup in a- 
sand-bath, poured half an ounce of sulphuric acid into the cup, to 
which he gradually added half an ounce of pulverized nitrate of 
potassa, so as to occupy an hour each night in the disengagement 
of the vapor. The application did not provoke cough, and the 
child usually fell asleep at an early hour. The treatment began 
on the night of July 30th, and after that of August 1st there was 
no more whooping, and in ton days the child, was well. Dr. 
Thomas concludes thus : " In the foregoing case it appears evident 
to me, and I trust it will to all those who read it, that the vis 
medicatrix nature had no agency in relieving the patient. I am 
willing at all times to pay due homage to that power, but not at 
the expense of truth and justice ; let us, therefore, 'render unto 
Ciesar that which belongs to Cresar,' and not ascribe merit where 
none is due." 

Dr. Nevins writes,* "Nitric, or rather, perhaps, ni- 
trous acid, is sometimes used as a fumigation by simply 
pouring a small quantity of fuming nitric acid into a 
saucer upon the table near which the patient is sitting. 
In some cases of phthisis, and of chronic bronchitis, 
with excessive expectoration, the acid fumes, thus dilu- 
ted with air and received into the lungs, have produced 
great relief by checking the secretion and improving the 
condition of the mucous membrane generally. It is 
quite under the patient's control, and may be used two 
or three times a day, according to circumstances and the 
relief produced." 

Hydrogen. 

Hydrogen gas, mixed with common air, was employed 
by Beddoes in the treatment of some chronic affections 
of the respiratory organs, including phthisis, under the 
opinion that an air less rich in oxygen than common air 

* The Prescriber's Complete Handbook, London, 1858, p. 133. 



AIRS, GASES, VAPORS, AND FUMES. 83 

would produce narcotic effects. He found it to relieve 
pain and promote sleep in phthisis and in the inflam- 
matory period of bronchitis. He administered it for a 
quarter of an hour in the proportion of one-eighth part, 
in a case of inflammation of the chest, and found it to 
relieve the severe pains and reduce the fever. A few 
other authors have reported similar results. Demar- 
quay* quotes a case cited by Berzelius, in which a 
young phthisical girl, tormented with insomnia, was 
enabled to sleep peaceably after a quarter of an hour's 
inhalation of a mixture of four parts of hydrogen with 
one of oxygen, the effect being reproduced each time the 
experiment was repeated. 

Sulphuretted Hydrogen. 

The emanations of sulphuretted hydrogen from min- 
eral springs have long been employed in Germany and 
in France, in the local treatment of various affections of 
the pulmonary organs, including non-febrile phthisis, 
catarrhs of the larynx, trachea, and bronchi, emphy- 
sema, asthma, hooping-cough, and catarrhs of the nasal 
passages, frontal sinuses, and pharynx. f 

Carbonic Acid. 

Inhalations of carbonic acid gas were employed by 
Percival, in 1774, as a palliative in the latter stages of 
pulmonary phthisis. j Dobson,§ and other of his con- 

* Op. cit, p. 854. 

f Waldenburg, op. cit., pp. 725-728. 

J Priestly, op. cit. 

\ A Medical Commentary on Fixed Air. Chester, 1779, p. 51. 



84 THE INHALATION OF 

temporaries,* also recognized the good effects of the 
inhalation of carbonic acid gas in confirmed phthisis. 
With Beddocs, they resorted to it for the purpose of di- 
minishing the amount of oxygen inspired into the lungs 
in diseased conditions, in which that gas was believed to 
be too stimulating ; and they report beneficial anaesthetic 
and antiseptic influence from these inhalations. In 
Germany and elsewhere similar favorable results were 
reported, a few of them quite remarkable ; more or less 
details of which are furnished by the authors cited. 

The inhalation of the gas at the sources of mineral 
waters containing it in considerable quantities has also 
been tried with some success. Demarquay cites the ex- 
periments of Goin, at St. Albans, in 1834, of Nepple at 
the same resort, in 1846 ; and Waldenburg,f those 
of Spengler at Ems, in 1855, and others. Of late 
years these inhalations have been employed at various 
other Continental resorts also, in the treatment of 
phthisis, asthma, chronic and fetid coryza, and chronic 
inflammations of the air-passages. The gas is usually 
collected in a bell-glass or other apparatus, to which a 
flexible tube is attached, by means of which the gas is 
directed into the mouth. At Franzenebad a large basin 
has been constructed, at the bottom of which the gas is 
disengaged, the upper stratum of air containing fifteen 
per cent. As the patients become accustomed to the 
gas they descend lower into the basin, and thus nearer 
the orifice from which the gas escapes. Willemin, who 



* Francis Home, Clinical Experiments, etc. Edinburgh, 1779. 
Simmons, Practical Observations on the Treatment of Consump- 
tion. London, 1779. Demarquay, op cit., p. 475. 

f Op. cit., p. 720. 



AIRS, GASES, VAPORS, AND FUMES. 85 

gives some of the above details, and others,* considers 
that these inhalations are especially efficacious in chronic 
inflammations with atony of the mucous membrane, 
and exaggerated secretion, and in nervous affections of 
the respiratory organs ; but that they ought to be avoided 
in phthisical cases. 

Demarquay, whose researches on carbonic acid are no 
less interesting than those on oxygen, to which we have 
already had occasion to refer, after a number of pre- 
liminary experiments upon animals, experimented upon 
himself, f After inspiring twenty litres of a mixture of 
eighteen parts of oxygen and two of carbonic acid, he ex- 
perienced a sensation of intense heat in the entire chest, 
but particularly at the middle of the epigastrium; a 
sensation which persisted for about a quarter of an hour. 
During the terminal inspirations his countenance be- 
came somewhat injected, and the respiratory movements 
became accelerated despite his desire to respire slowly. 
Vertigo ensued, preceded by slight cephalalgia, but it 
was slight and disappeared one or two minutes after 
the completion of the experiment, which occupied about 
four minutes. There was no appreciable change in the 
state of the pulse. Increasing the proportion of car- 
bonic acid to one-fourth of that of oxygen, the gas, taste- 
less in the lesser proportion, acquired a special acid taste 
by no means disagreeable. At the end of a few in- 
spirations there was a perception of great heat at the 
epigastrium, irradiating through the entire chest; and 
a special sensation, in some sort instinctive, that the air 
being respired was not suitable for his organism. This 

* (Union med., July 15th, 1858; Brit, and For. Med.-Chir. 
Kev., Jan. 1859) ; Am. Jour. Med. Sci., A.pril, 1859, p. 544, 
f Op. cit., p. 441. 

8 



86 THE INHALATION OF 

sensation, more subjective than objective, evinced itself in 
an imperious desire to refill the apparently empty lungs, 
thus producing a forced acceleration of the respiratory 
movements. At the close of the experiment his face was 
very red, his eyes a little prominent, and respiration anx- 
ious and panting. A T ertigo was more pronounced than in 
the first experiment, and of longer continuance ; and the 
heat in the chest remained sensible for an hour afterwards. 
The pulse became increased at first from 76 to 84, which 
is a matter of no moment, as it may have been due to 
the acceleration in the respiration ; but it afterwards be- 
came less strong and less perceptible. Some of Demar- 
quay's pupils respired similar mixtures, with the same 
general results in different degrees, some of them being 
but little susceptible to its influence. A mixture of one 
part to three of oxygen was almost insupportable to him- 
self, while it was readily supported by some of his pupils. 

In 1866, Dr. James Collins, of Philadelphia, and my- 
self, made some experiments in the inhalation of carbonic 
acid from reservoirs in which the gas had been forced un- 
der compression ; chiefly, however, with a view as to the 
safety of its employment as a nebulizing agent in the pro- 
duction of sprays for inhalation, but our results were not 
recorded, and we have never repeated the experiments. 
Our conclusions were, however, that the admixture of 
gas with the spray was not attended with the danger we 
had anticipated. Dr. Collins inhaled the spray thus pro- 
duced for half an hour continuously, without experienc- 
ing any unpleasant effects from the carbonic acid gas. 

When an attempt is made to inhale the undiluted gas, 
a spasm of the glottis is provoked and the entrance of 
the gas excluded. In moderate dilution it is simply ir- 
respirable; but in larger dilution than that supposed to be 



AIRS, GASES, VAPORS, AND FUMES. 87 

noxious ill common air, it may be inhaled for some min- 
utes continuously, with little or no inconvenience, accord- 
ing to the idiosyncrasy of the individual. This, there- 
fore, as remarked by Demarquay,* affords time enough 
to produce a therapeutic effect, if the use of the gas is 
indicated. Demarquay suggestsf that the emanations 
from earth-baths, found useful in phthisis and other 
diseases, is due to the carbonic acid of which they are 
in great part composed. 

Much of the benefit attributed by Beddoes and his 
contemporaries to residence in or near cow-stables, in 
cases of phthisis, is judged to have been due in part to 
the carbonic acid gas exhaled by the cattle. 

Sir J. Simpson deemed inhalation of this gas beneficial 
in chronic bronchitis, asthma, and irritable cough. J 

Carburetted Hydrogen. 

The vapors of illuminating gas, carburetted hydrogen, 
have been successfully employed in the treatment of 
whooping-cough. Early in 1864, at Amsterdam, children 
with this affection were sent to the place of manufacture of 
the illuminating gas, and allowed to breathe the gaseous 
atmosphere for a certain period, with very satisfactory 
results, many cases having been considered to have been 
cured in this manner, and without injurious consequences 
in any one instance. 

The same method was employed at Calais in the winter 
of 1864, during an epidemic of pertussis, a number of 
children thus affected being sent to the gas-house to 
breathe the vapor at the moment of escape after sub- 
jection to the purifying process. As soon as the children 

* Op. cit., p. 459. f Op. cit., p. 471. 

X Kinger's Therapeutics, New York, 1875, p. 53. 



88 THE INHALATION OF 

breathed this air they began to improve, and thorough 
cures resulted. Two or three visits sufficed to put an 
end to the paroxysms of cough. 

Other investigations were made in this direction about 
the same period. Thus, M. Com merge presented to 
the Imperial Academy of Medicine, a report* on this 
subject drawn up from the observation of the effects pro- 
duced on one hundred and forty-two children affected 
with whooping-cough, who had been subjected to the 
action of the gases in the gas-works at St. Maude. 
His conclusions are to the effect that the treatment pro- 
duces excellent results, and at all periods of the disorder. 
In general, twelve seances are required for the cure, and 
each seance should be of two hours' duration. How- 
ever young the patients, no danger results from the 
exposure to the gases. Then again, Dr. Bertholles in- 
forms the French Academy of Medicine of the effects 
observed to result from the inhalation of the vapors dis- 
engaged from the remains of the materials used in the 
purification of gas, by children having whooping-cough. 
The register of the coal-works atTernes shows that during 
a series of six months, nine hundred and one patients had 
been subjected to this vapor treatment, and that of these, 
two hundred and nineteen were cured, and one hundred 
and twenty-two relieved. The favorable results are prob- 
ably due to the amraoniacal gases and the tar vapor as- 
sociated with it.f 

In this connection it will be interesting to record here 
the results of some experiments performed upon cases 

* Am. Jour. Med. Sci., April, 1865, p. 487, from Brit. Med. 
Jour., Nov. 5th, 1864. 

f See more recently on the same subject, Schmidt's Jahrbucher, 
July, 1866, p. 63. 



AIRS, GASES, VAPORS, AND FUMES. 89 

of whooping-cough, at the St. Annen Children's Hospital, 
of Vienna, with the view of determining the effect of 
the inhalation of various gases in the treatment of this 
affection. 

These results are summed up as follows : 

1st. Inhalation of pure oxygen gas did not, in any instance, pro- 
duce paroxysms of cough. 

2d. Inhalation of nitrous oxide gas, or of a mixture of oxygen 
and atmospheric air in equal parts, did not produce a single par- 
oxysm of cough, even when the inhalation was continued for a 
considerable period. The children inhaled it with eagerness for 
from live to ten minutes, and would have continued to do so 
longer, had permission been allowed. 

3d. Inhalation of pure nitrogen and hydrogen was attempted 
only on a single occasion ; the children breathed it very unwil- 
lingly, and only for a very short period. In two cases, the inha- 
lation of nitrogen was interrupted by paroxysms of cough. In- 
halation of hydrogen produced disposition to cough in one case. 

4th. The inhalation of carbonic acid gas always produced a very 
heavy fit of coughing at the first deep inspiration, even when the 
experiment was continued for a very short time. An experiment 
was made with a mixture of one volume of carbonic acid gas with 
fifteen volumes of ordinary air, which always produced a fit of 
coughing, either immediately or within two or three minutes. 
With further dilution the result was not constant, but fits of cough- 
ing followed much more frequently than from the inhalation of 
pure atmospheric air. 

5th. A very slight proportion of ammoniacal vapor, so slight 
that it could not be detected by the sense of smell, was followed 
by constant severe paroxysms of cough in the limited number of 
cases in which it was tried. 

Dr. Hauke, in summing up the practical results of 
these experiments, and arguing from the fact that car- 
bonic acid gas is the gas most obnoxious to whooping- 
cough, on the ground that there is some arrest of the 
separation of carbonic acid gas in the lungs, puts the 
following question : Does this arrest or hindrance to 
the separation of carbonic acid gas from the lungs of 



90 THE INHALATION OF 

children laboring under whooping-cough, throw any 
light upon the cause of the peculiar fits of coughing? 
His anatomical and clinical experience assures him that 
such is the case ; and although his investigations have 
not furnished any specific remedy against whooping- 
cough, some valuable assistance has been gained in de- 
creasing the number and severity of the paroxysms of 
cough. 

These investigations appear to substantiate the old 
advice to permit whooping-cough patients, free from 
fever, to be out in the open air as much as possible on 
still, sunny, summer days. In the confined space of a 
sick-room, the air loaded with carbonic acid gas, and 
the volatile ammoniacal particles of the various excre- 
tions, is in itself sufficient to induce cough. Out in the 
open air, on the contrary, where nature furnishes in 
every leaf an apparatus for the generation of oxygen, 
not only is such injurious effect prevented, but the 
greater liberation of carbonic acid gas, by promoting 
the respiratory process, will have a calmative effect 
upon the paroxysm. When the state of the weather is 
such as to prevent the egress of the child into the open 
air, it is advisable on the same grounds to place in the 
chamber some many-leaved, blossomless plants, meagre 
in perfume, so as to increase the proportion of oxygen in 
the atmosphere of the apartment ; particularly for a few 
hours after a meal, because at this time the production 
of carbonic acid in the organism reaches its maximum. 
For similar reasons, such articles of nutrition should be 
selected as are least productive of carbonic acid gas, 
and which, by their high oxidation, require but a small 
quantity of oxygen for their combustion in the system. 
Therefore the diet most appropriate under such circum- 



AIRS, GASES, VAPORS, AND FUMES. 91 

stances is one rich in fatty constituents, such as milk, 
sugar, and starches. On the same principles great at- 
tention should be paid to the condition of the skin, by 
the use of frequent ablutions, baths, etc.* 

The inconvenience often attendant upon sending 
children with whooping-cough to the gas-works, a prac- 
tice which he had pursued with good effect in 1864, led 
Dr. Lochnerj" to the attempt to employ at home, in the 
case of his own son, one of the substances contained in 
the purifying chambers of the gas-works ; and he selected 
benzine, with the vapor of which he kept the room im- 
pregnated by pouring a few drops upon the bed of the 
patient. In the case of his own child, in whom the 
paroxysms were very violent, though only numbering 
five or six in the twenty-four hours, the disease lasted 
but six days. He also employed the benzine internally, 
ten or fifteen drops daily in a little water ; and when 
the child was sleeping, sprinkled a few drops upon the 
bed. 

Chlorine. 

It has been asserted that paper-makers, though ex- 
posed to the fine dust from the rags, and the like, are, 
as a class, peculiarly exempt from phthisis, and on ac- 
count of their exposure to the fumes of chlorine; and it 
is probable that this circumstance originated its sugges- 
tion as a remedial agent by inhalation. 

Gannal, observing in 1819 that in a bleaching estab- 
lishment, workmen who suffered under diseases of the 
chest, were visibly improved, ascribed the amelioration 
to the inhalation of air containing this gas, and he was 

* (Jahrb. fur Kinderheilkunde, 1862; M«ed. Neuigk. fur Aerts- 
ter, Erlangen, 1862, No. 22); Lewin, op. cit, p. 202. 
f Gazette medicale, Oct. 20th, 1866. 



92 THE INHALATION OF 

led to institute experiments upon consumptives. His 
results were good. He read a memoir on the subject, 
before the Parisian Academy of Sciences, Jan. 8th, 1828, 
exhibiting an apparatus which he had devised for ad- 
ministering inhalations of the gas, and recommending 
its use as a curative agent in phthisis.* 

The inhalation of chlorine was recommended by Bret- 
onneau in diphtheritis, when the false membrane had 
entered the larynx. 

Laennec mentioned its use favorably in his clinical 
lectures, f 

Sir James Murray hasstatedj that a friend of his had 
observed beneficial effects in consumption, among his 
workmen, from exposure to the inhalation of a watery 
vapor strongly impregnated with chlorine. 

Dr. Cottereau§ reported thirteen cases in which all 
the signs were decisive of phthisis, and in which recovery 
ensued under inhalations of chlorine. One of these is 
described as a remarkable case of consumption of the 
w r orst kind. This patient, some two years after having 
been cured of his consumption, died from acute inflam- 
mation of the mucous membrane of the stomach and 
small intestines, without any derangement of the respira- 
tory system ; and the post-mortem examination revealed 
the presence of the old cicatrices, and some crude tuber- 
culous granulations. 

* Two Memoirs on the Inhalation of Chlorine, etc. Translated 
by W. H. Potter. London, 1830. 

f Revue med., 1823, 1, p. 296. 

J (A Dissertation on the Influence of Heat and Humidity, etc. 
London, 1829, p. 126) ; Corrigan, Dublin Jour. Med. Sci., March, 
1839, p. 96. 

\ De l'emploi du chlore gazeux dans le traitement de la phthisie 
pulmonaire; Arch. gen. de mid., 1830, xxiv, p. 347. 



AIRS, GASES, VAPORS, AND FUMES. 93 

Sir Charles Scudamore, who tried chlorine in several 
instances of phthisis, found it inferior to iodine, his 
favorite remedy. 

Louis was willing,* on the evidence of Gannal, Mur- 
ray, Scudamore, and Cottereau, to acknowledge the pallia- 
tive effects of chlorine (and iodine) in phthisis, but he 
subsequently reportedf that in a number of experiments 
with more than fifty consumptive patients at La Pitie, 
the Hotel Dieu, and elsewhere, he had not obtained any 
successful result from the inhalation of chlorine gas ; 
though he has elsewhere admitted that singular advan- 
tage may be obtained from chloruretted inhalations in 
certain cases of chronic bronchitis, even where the gen- 
eral symptoms closely resemble those of phthisis. 

Dr. ElliotsonJ found great mitigation from inhalations 
of chlorine in two cases of phthisis, and found them 
secure greater amelioration than narcotics or any other 
means then employed. 

Dr. A. T. Thompson§ considered chlorine the best 
topical expectorant and the most salutary excitant to 
the mucous membrane that had yet been inhaled. He 
speaks highly of its palliative influence in phthisis, 
having found it give such relief, even in advanced cases, 
as "to have scattered flowers on the borders of the 
grave." 

Toulmouche|| found inhalations of chlorine to effect 

* Pathological Researches on Phthisis, translated hy Cowan, 
Washington, 1836, p. 287. 

f Recherches anatomiques, pathologiques et therapeutiques sur 
la phthisie, Paris, 1843. 

| The Lancet, 1830-31, ii, p. 198. 

§ Materia JMedica. 

|| Arch. gen. de med., 1834, iv, p. 576. 



94 THE INHALATION OF 

temporary improvement in phthisis, facilitating expecto- 
ration, and improving the appetite. In chronic bron- 
chitis it yielded him the most brilliant results. In one 
hundred and forty-one cases of acute bronchitis* recovery 
ensued in from five to fifteen days. In sixty-five cases 
of chronic bronchitis, four of which were complicated 
with pulmonary emphysema, the results were likewise 
unusually satisfactory ; recovery ensuing in from sixteen 
to twenty-seven days. He employed a simple inhaler 
(Fig. 3, p. 21) one-fourth filled with warm water, to 
which from ten to forty drops of chlorine-water were 
added. The inhalations were administered from four 
to six times a day, each inhalation occupying from ten 
to fifteen minutes. 

Dr. Stokes found these inhalations prejudicial in 
phthisis, being too provocative of irritation. He found 
them beneficial, however, in correcting fetor in gangrene 
of the lungs. Laennec and others also failed of success 
with chlorine inhalations in phthisis, and even found 
them occasionally injurious. Morton, of Philadelphia,f 
and Little;}; found them more injurious than useful. 

Inhalation of chlorine is said to be a most efficient 
agent in poisoning by hydrocyanic acid, and in poison- 
ing by sulphuretted hydrogen. § 

Chlorine gas, in proper dilution for inhalation, may 
be evolved by mixing one or two drachms of the chlor- 
ine-water with a couple of ounces of hot water, and 
placing the vessel in a hot bath, or over a flame ; or it 

* Gaz. med., Paris, 1838, No. 26; Waldenburg, op. cit., p. 
687. 

f Illustrations of Pulmonary Consumption, Philadelphia, 1834. 

% Dub. Med. Jour., March 1st, 1834. 

I Dunglison's New Kemedies, 7th Edition, p. 202. 



AIRS, GASES, VAPORS, AND FUMES. 95 

may be inhaled by adding water to chloride of lime in a 
Wolfe's bottle or other inhaler. 

Dr. Corrigan employed a special apparatus,* which 
has already been described (p. 31). He directs that 
eiodit ounces of a saturated solution of chlorinated lime 

o 

be poured into the glass globe ; and into the water of the 
porcelain dish, two ounces of the diluted sulphuric acid 
of the Pharmacopoeia. As the solution drops, the acid 
seizes on the lime, and the chlorine is evolved in connec- 
tion with aqueous vapor. 

Prof. Joseph Pancoast, of Philadelphia,! reports the 
cure of a particular form of aphonia by means of the 
inhalation of the vapor of chlorine. The form of 
aphonia is that inferred to be due to partial paralysis of 
the intrinsic muscles of the larynx. 

As an inhaling apparatus, Dr. Pancoast used the 
ordinary tubulated glass retort of the chemist, with a 
glass funnel having some filtering-paper at the bottom. 
In the bowl of the retort- lie placed a solution of the 
chloride of soda, or lime. Into the glass funnel was put 
a weak solution of muriatic acid in water. As the dilute 
acid fell drop by drop into the bowl of the retort, chlorine 
was very gradually liberated and breathed from the end 
of the instrument. 

In using this apparatus, some care is required that the 
acid solution should not be allowed to drop too freely 
on the salt in the bowl of the retort, so as to develop 
the gas too freely. But the patient has the means of 
protecting himself against too strong an impression of 
the chlorine on the glottis, by diluting it with air drawn 



* Dab. Jour. Med. Sci., 1834, 43, p. 94. 

f Trans. Am. Med. Ass'n., 1850, vol. iii, p. 135. 



96 THE INHALATION OF 

in through the nostrils, a measure to which he would 
instinctively resort. 

" The first case in which this method was employed, was a 
healthy young country girl, who had contracted a severe cold by 
remaining in a damp spring-house. The aphonia had lasted for 
six months, resisting every sort of treatment. 

"She was placed upon the inhalation of chlorine, continued for 
some minutes, and repeated two or three times a day, according 
to the degree of iritation it produced in the throat and larynx. 
From the first trial, the patient's voice improved, and in three 
days had become very nearly as strong as ever. A couple of 
months after her return to the country, another cold was followed 
by a similar case of aphonia. The patient again breathed the 
dilute chlorine vapor for a few times, and had her voice restored. 

" The second case was that of a well-known practitioner whose 
voice had been lost for about seven months, so that he was unable 
to practice his profession. Besides exhausting the means more 
ordinarily resorted to in these cases, he had made, without any 
good effect, repeated trials of a strong lunar caustic solution 
applied with a sponge to the glottis. 

" His voice began to improve from the first trial of the chlorine. 
The improvement was steady, but more slow than in the case above 
detailed, a week or ten days elapsing before his voice was restored 
to its natural strength." 

Dr. Pancoast very properly considers that the chlo- 
rine acts merely as a local stimulant, and that iodine, or 
any other exciting vapor would effect similar results. 

Chlorine has likewise been recommended by inhala- 
tion in diphtheria. Mr. C. F. Hodson recommends 
the inhalation of the vapor of boiling water mixed with 
a portion of a solution of chlorinated lime.* 

Iodine. 
The close resemblance between tuberculosis and scrof- 
ulosis, and the well-known alterative eifects of iodine 

* (Brit. Med. Jour., March 8th, 1859); Am. Jour. Med.'Sci., 
April, 1859, p. 545. 



AIRS, GASES, VAPORS, AND FUMES. 97 

upon diseases of the latter character, especially as they 
affect lymphatic and other glands, naturally led to the 
employment of the same remedy in pulmonary con- 
sumption ; and the volatile nature of iodine suggested 
its employment by inhalation, for the treatment of affec- 
tions of the respiratory organs. This vapor has been 
found of decided efficacy in confirmed phthisis, and in 
certain forms of catarrh, by many well-known authorities. 

Laennec, attributing the infrequency of pulmonary 
tuberculosis on the English coast to the iodized vapor 
escaping from sea-weed, and the beneficial effects of sea- 
air in phthisis to the iodine present in such an atmos- 
phere, tried, in 1825, the effect of an artificial sea-air, 
from which he anticipated important results. He kept 
twelve patients in this atmosphere for four months. 
The disease remained stationary in all of them, and the 
emaciation and hectic fever underwent remarkable dimi- 
nution in several of them. Nine of these patients, be- 
lieving themselves cured, declined to remain any longer 
in the hospital. The three patients remaining under ob- 
servation could not be longer provided with the sea-weed 
in consequence of the difficulty of its transportation inci- 
dent to the season (spring), and the disease took a rapid 
course the moment the varec gave out, and soon termi- 
nated fatally. 

Direct inhalations of iodine were employed by Berton 
in 1828, who read a paper on the subject before the 
Parisian Academy of Medicine in 1829.* Dr. Berton's 
method consisted in placing into a flask with two open- 
ings some dilute sulphuric acid, to which is added a 
quarter or half a grain of the hydriodate of potash; the 

* Arch. gen. de med., xix, p. 134. 



98 THE INHALATION OF 

iodine vapors are promptly disengaged, and are inhaled 
by the patient from one of* the tubes from the flask, the 
process of inhalation occupying four or five minutes, 
and being repeated as often as desirable, even to the 
number of ten times a day. 

Sir James Murray,* as the result of his experience, 
felt assured that he had seen beneficial results from in- 
halation of the vapor of iodine in many instances, some 
of them undoubted cases of phthisis. He had always 
observed at least a temporary improvement of the gen- 
eral condition ; the cough becoming less severe, expec- 
toration more free, and sleep quieter. The plan em- 
ployed by him was to place a vessel containing iodine 
in such a position as to become traversed by a current 
of steam escaping from a vessel in its neighborhood ; or 
else he placed an open capsule, with moistened iodine, 
in a vessel of hot water. The patient, in this manner, 
breathed an iodized atmosphere continuously. He in- 
quires, very pertinently, whether the favorable results 
are not in part due to the equable temperature main- 
tained in the patient's apartment? 

Sir Charles Scudamore, one of the most enthusiastic 
advocates of the treatment under consideration, found 
the irritating qualities of the vapor subdued by the ad- 
dition of a small quantity of tincture of conium at the 
time of employing the inhalation, a higher heat being 
necessary to liberate the vapors from the conium than is 
necessary with iodine alone.f Hundreds of consump- 
tives treated by this method, though not cured, had ex- 

* A Dissertation on the Influence of Heat and Humidity, etc. 
London, 1830. 

f The Lancet, 1830-31, p. 189. 



AIRS, GASES, VAPORS, AND FUMES. 99 

periencecl considerable relief.* This observer, after ten 
years' experience with iodine inhalations, had acquired 
increased confidence in their efficacy. f His formula at 
this time was six grains each of iodine and iodide of 
potassium, with two drachms of alcohol to five ounces of 
distilled water, adding a little tincture of conium at the 
time of mixing the solution of iodine with the water for 
inhalation. He began with a drachm or so of the iodine 
mixture, two or three times a day, increasing the dose, 
if necessary, to as much as four drachms, and prolong- 
ing the duration of the inhalation. The apparatus em- 
ployed by Scudamore lias already been described (p. 23). 
Dr. Elliotson's experience with iodine in consumption 
had not been attended with results in any instance 
promising recovery, but he advised further continuance 
of the treatment.! Dr. Little not only failed to meet 
with any success with these inhalations, but even found 
them excite acute inflammation of the trachea.§ Stokes|| 
expresses his reprobation of the practice in the strongest 
language. Baudelocque, in 1838, If likewise derived but 
little benefit from them. The experience of Dr. Pereira** 

* Cases Illustrative of the Efficacy of various Medicines ad- 
ministered by Inhalation in Pulmonary Consumption, certain 
Morbid States of the Trachea and Bronchial Tubes, attended 
with distressing Cough, and in Asthma. London, 1830. 

Cases Illustrating and Confirming the Eemedial Power of the 
Inhalation of Iodine and Conium in Tubercular Phthisis, and 
various Disordered States of the Lungs and Air-passages. Lon- 
don, 1835. 

f London Med. Gazette, February, 1810. 

| The Lancet, 1830-31. 

| Dub. Med. Jour., March 1st, 1834. 

|| Diseases of the Chest, Philadelphia, 1837, p. 296. 

fl Gaz. hebd., 1854, i, 21. 

** Materia Medica, Philadelphia, 1843, vol. i, p. 232. 



100 THE INHALATION OF 

in phthisis, as well as in other chronic pulmonary com- 
plaints, had not been favorable. 

Piorry has been one of the chief advocates of the 
treatment of phthisis by inhalations of iodine,* and he 
treats of the method in terms of very high encomium. 
In a paper read before the Parisian Academy of Medi- 
cine, M. Piorry, after mentioning the circumstances in- 
ducing him to employ inhalations of iodine in the treat- 
ment of phthisis, states that the results of the experi- 
ments, instituted by himself in conjunction with M. 
Deyne, an interne of his service, were very satisfactory. 
A striking amelioration took place in many of their 
patients, this amelioration being permanent, inasmuch 
as several patients, whose cases had been mentioned in 
his Avork on Practical Medicine, were still in the enjoy- 
ment of good health. 

The successful treatment of hydrocele and tuberculous 
diseases of the testicle, by injections of solutions of iodine, 
justified the inference of anticipating similar benefit in 
pulmonary excavations; but the difficulty, not to mention 
the temerity, of attempting the injection of tincture of 
iodine into a pulmonary cavity,f or into the air-passages, 
led M. Piorry to the plan of employing the vapor of 
iodine. Sometimes the crystals of iodine were employed 
to evolve the vapor, and sometimes the tincture of iodine 
was used. In the former instance, one or two scruples 
of iodine were placed in a wide-mouthed quart jar, from 

* Gaz. des hop., 1850, 84; Arch. gen. de med , March, 1854, p. 
361 ; (Comtes rendus, January 24th, 1854); Ranking's Abstract, 
1854, xx, p. 70. 

f Since performed by Mosler, Berliner klin. Woch., 1873, No. 
43; London Medical Record, Jan. 28th, 1874, p. 52; and by Pep- 
per, Philadelphia Med. Times, March 14th, 1874, p. 369. 



AIRS, GASES, VAPORS, AND FUMES. 101 

which the vapor was disengaged spontaneously with more 
or less rapidity, according to the degree of heat and 
moisture of the atmosphere. In other instances, one 
to three ounces of the tincture of iodine were poured 
into the jar, which was then heated until the vapors of 
iodine and alcohol were liberated. The patients breathed 
the vapors contained in these recipients, taking one deep 
sighing inspiration at a time, and repeated the effort 
from one to two hundred times daily, at appropriate in- 
tervals. Several successive inspirations will produce 
pain in the larynx and bronchi, with cough, although 
single inspirations do not produce much irritation. 

Like Laennec, who surrounded the bed of his con- 
sumptive patients with varec, to insure continuous inha- 
lation of the iodinized vapor, Piorry, too, desired that 
his patients should inhale iodine even during sleep. 
For this purpose he had several saucers containing 
iodine placed about the patient's pillow. In the hospi- 
tal he attached a number of vials of iodine to the iron 
frame supporting the bed-curtains, so as to saturate the 
air with iodine, which is given off in sufficient quantity 
to blue the starched curtains and produce various tints 
on the iron of the bedsteads. 

Piorry states, that if a moist starched paper is inter- 
posed between the jar containing iodine and the patient's 
mouth, as he takes an inspiration, it turns blue ; while 
the same air breathed upon the paper, after having trav- 
ersed the lungs, causes no change; from which fact he 
infers, that the iodine which enters the lungs is absorbed 
there, during the brief sojourn of the air in the air- 
vesicles. 

The treatment of Piorry's cases was not confined to the iodine 
inhalations. Most of them took from twenty to sixty grains of 

9 



102 THE INHALATION OP 

the iodide of potassium by the stomach daily. In cases of sup- 
posed adhesions, frictions were resorted to with tincture of iodine, 
diluted with nineteen parts of water. Other remedies were given 
in some cases to fulfil various indications ; while a nutritious and 
reparative diet was employed, a regimen to which Piorry gives a 
preference over all the whole category of remedies except iodine. 

Thirty -one patients were thus treated during a period 
of two years, all presenting in different degrees the 
symptoms commonly attributed to pulmonary phthisis; 
the majority of them with diarrhoea, and many of them 
with laryngeal involvement. In every instance the 
plessi metric and stethoscopic signs were positive. 

In order to determine with precision the effects of the 
iodine, some charts were prepared, upon which were 
marked exact delineations of the parts diseased, and 
representations of the variations in sound upon percus- 
sion, as they occurred from day to day. After periods 
varying from four, six, or twenty days, to from six 
weeks to four months of the iodine treatment, there was 
in almost every case a diminution of the extent of the 
surface over which there was at first feebleness of respi- 
ration, dulness, resistance, etc., while at the same time, 
the stethoscopic signs indicated an amelioration in the 
condition of the condensed portions of lung. Numer- 
ous patients with cavities in the lungs were apparently 
cured. The ultimate results w r ere: decided amelioration 
in the symptoms and anatomical characters in twenty 
cases ; disappearance of the anatomical characters and 
of most of the symptoms in seven cases ; death with or 
without amelioration in four cases. 

After some reflections as to the manner by which the 
iodine operates in the case of. phthisis, M. Piorry con- 
cludes as follows : 



AIRS, GASES, VAPORS, AND FUMES. 103 

1st. The inhalation of the vapor and tincture of iodine 
is useful in the cure of phthisis ; 

2d. In many cases, such inhalation is followed by a 
diminution in the extent of the indurated parts surround- 
ing tuberculous deposits, and an amelioration in the gen- 
eral symptoms ; 

3d. It is probable that tubercle itself disappears under 
the influence of iodine inhalations ; 

4th. That inhalations of the tincture of iodine may 
promote the cure of tuberculous cavities ; 

5th. That after the softening of tubercles, the result- 
ing cavities may cicatrize spontaneously ; 

6th. That compression of the thorax over the points 
of disease indicated by percussion and auscultation, may 
contribute to the cure of the local lesion, and to the pre- 
vention of pyremia ; 

7th. That iodide of potassium administered internally, 
and frictions with diluted tincture of iodine over adher- 
ent portions of the lung, are also of great utility. 

Some years later, Piorry reported continued success 
with this method of treating consumption.* 

Huette, of Montarges, in 1849,f proposed the use of 
hydriodic ether in all cases in which it was desirable to 
saturate the system quickly with iodine, and when we 
wish to carry this agent directly into the lungs. A 
spoonful of water, mixed with seven or eight drops of 
the ether, is put into a wide-mouthed jar. The ether 
falls to the bottom, and the patient inspires the air con- 
tained in the upper part of the glass, while he holds the 
bottom of it in his hand to favor the volatilization of the 

* Gaz. des hop., March 21st, 1861. 

f (These, Paris, 1849), The Preserver's Complete Handbook, 
London, 1858, p. 251. 



104 THE INHALATION OF 

ether. The whole of the ether is generally absorbed in 
ten minutes ; and in a quarter of an hour afterwards 
iodine is found abundantly in the urine, and it may be 
found there for some time. 

M. Simon relates* the results of a number of cases of 
phthisis pulmonalis treated by M. Chartroulle with in- 
halations of iodine, a practice very frequent in Belgium. 
Under his directions, twenty-eight hospital patients 
were treated by the inhalation of the vapor of pure 
iodine; and of this number only eleven could be said to 
have derived no benefit from the treatment. In these 
unsuccessful cases the pulmonary lesions were not modi- 
fied, but still the symptoms were not aggravated in any 
instance. In opposition to the statement that iodine 
vapor produces haemoptysis, it was found that pulmo- 
nary haemorrhage ceased more rapidly under this kind of 
treatment than under other plans which are more gen- 
erally employed. Seventeen patients derived positive 
benefit from the iodine treatment, and this improvement 
was observed not only in relation to the general symp- 
toms, but also to the pulmonary lesion itself, as was 
proved by percussion and auscultation. Out of the sev- 
enteen patients, but four might be considered as actually 
cured. One of these cases of cure is the following : 

A youth, sixteen years of age, entered the hospital in such an 
alarming condition that at first the physicians hesitated to submit 
him to the iodine inhalations. He was in a state of great emacia- 
tion, and his skin was almost constantly covered with profuse 
perspiration ; he had diarrhoea,, which had lasted for two months, 
and he had repeatedly suffered from haemoptysis. There were 
very extensive indurations in the lungs, and at the apex of the 

* Brit, and For. Med.-Chir. Kev., July, 1861, from Union 
medicale, March 16th, 1861. 



VAPOKS, AND FUMES. 105 

right lung there was a cavity of some size, as was shown by very 
obvious gargouillement. The expectoration also was character- 
istic. After resting a few days, this young man was subjected to 
the iodine inhalations, and all the symptoms which had appeared, 
so serious were soon modified in a most remarkable manner. The 
general symptoms disappeared first, and the body recovered its 
plumpness with great rapidity. The perspiration, diarrhoea, 
fever, cough, and expectoration, were soon relieved, or removed; 
and six weeks after admission into the hospital the patient went 
out quite well. 

Several other cases of the same nature are recorded 
from both the public and private practice of M. Char- 
troulle, and in all of them the beneficial results of iodine 
inhalations are remarkably exhibited. Dr. Simon, who 
relates the cases, attributes a great part of the efficacy 
of the treatment to the apparatus employed for inhala- 
tion, which, however, is not described in the paper. * By 
this apparatus, it appears, a degree of precision is given 
to the treatment, which consequently becomes the more 
efficacious, for a dose of the vapor may be estimated 
with exactness, and the remedy may be made propor- 
tionate to the intensity of the disease and the strength 
of the patient. 

Lewinf had employed vapor of iodine in phthisis 
several times without any favorable results ; but all his 
cases were in the advanced stage. 

The inhalation of iodine vapor has been employed in 
coryza : 

An army surgeon, M. Luc, seized with very bad coryza, at- 
tended by fever, severe cephalalgia, and excessive secretion, de- 
termined upon trying the effect of the inhalation of iodine vapor. 
The coryza first appeared at 9 a m\, and the inhalations were com- 

* Chartroulle originally (1851) recommended ioduretted ci- 
garettes. 

f Op. cit., p. 202. 



106 THE INHALATION OP 

menced at 3 p.m., being repeated everj*- three minutes during an 
hour, each inhalation lasting about a minute. The headache was 
first relieved, the sneezing then occurred less frequently, the amount 
of secretion diminishing; and by 6 p.m. all traces of the coryza 
had disappeared, except a little burning sensation in the throat. 

Several army officers subsequently tried the means with 
the same results. The inhalation is effected by placing 
a bottle of tincture under the nose, the hand supplying 
warmth enough to vaporize the iodine.* 

Dr. Ringer recommends the following method of ad- 
ministration in patients troubled with daily coryza :f 
"A jug of the capacity of a quart is heated by rinsing 
with boiling water ; then partially filled with boiling 
water, into which from twenty to thirty drops of the 
tincture of iodine are poured. The jug and the head of 
the patient are covered with a towel. The inhalation 
is used night and morning for five or more minutes." 

Dr. A. P. Merrill, of New York, formerly professor 
of Materia Medica in the Memphis Medical College, 
and editor of the Memphis Medical Recorder, has for a 
number of years made extensive use of the inhalation of 
the vapors of iodine in mucous inflammations of the 
trachea and bronchi, led to the treatment by the happy 
results previously obtained in his own case and that of 
others, by its local application, in a convenient form, in 
cases of chronic pharyngitis and laryngitis, j 

Dr. Merrill employs the vapor disengaged directly 
from the crystals of iodine, which are sufficiently volatile 

* Rev. med., August 31st; Med. Times and Gazette, Novem- 
ber 11th, 1865; The Med. Record, March 1st, 1866. 

f Handbook of Therapeutics, New York, 1875, p. 83. 

% These cases are reported in the Memphis Medical Recorder, 
vol. i, 1852-3, pp. 8, 21, 113; vol. iii, 1854-5, pp. 133, 187, 228, 
285; vol. iv, 1856, pp. 252, 377. 



AIRS, GASES, VAPORS, AND FUMES. 107 

in a current of cold air to afford all the strength of 
vapor that can be conveniently borne by the patient. I 
make a few extracts from some communications on this 
subject, kindly furnished me by that gentleman. "In 
a case of such inflammation beyond the reach of the 
brush, I found a patient inhaling the vapor of gum cam- 
phor through a common quill, but without much effect. 
I added a few grains of iodine to the camphor, and then 
the relief obtained was more decided ; but in applying 
this combination to other cases, I met witli a difficulty 
in the liquefaction of the mixture, and then determined 
to use each remedy separately, by placing it within a 
small cane tube, with a little coarse wool in each end 
to prevent the escape of the medicine. I have used 
tubes of glass, also, but found them to hold the remedies 
less securely. The cane tubes have answered an excel- 
lent purpose, whether employed through the medium of 
the mouth or the nasal passages ; but more recently I 
have substituted tubes made of hard rubber, so rounded 
at the ends as to prevent irritation, and the vapor es- 
capes through several perforations at the extremity. 
With these tubes, which unscrew at the middle for the 
introduction of the iodine, the teeth, tongue, etc., are 
protected from any disagreeable effects of the vapor, 
and the current may be made to impinge in any desired 
direction. 

"Great benefit is derived from iodine inhalations in 
the more acute affections of the nasal membranes, such 
as coryza, hemorrhage, and catarrh. They relieve the 
habitual catarrh of old people, and are advantageous to 
public speakers and singers, whose vocal organs have 
become debilitated from excessive exercise in their voca- 



108 THE INHALATION OF 

tions, and which sometimes show a tendency to cedema 
of the glottis, and terminate in aphonia." 

Dr. Merrill details* an interesting case of symptom- 
atic bronchial irritation, in which the iodine inhalations 
were very beneficial. These were made with tubes of 
cane in the manner previously described. He considers 
that the iodine acts in chronic cases by exciting a watery 
secretion which disengages the viscid mucus, which fre- 
quently induces coughing by its titillation ; and that it 
relieves hyperemia and hypertrophy. He has found 
benefit from inhalations of iodine vapor in croup, in 
cedema of the glottis, and in aphonia. 

In cases of children, and people unwilling or unable to 
inhale properly, he attaches a gum hand-bellows by a 
rubber tubing to the tubes, and thus forces the vapor 
into the nasal or laryngeal passages. 

Dr. Merrill has kindly furnished me with the follow- 
ing notes of a case of profuse bronchorrhcea, which was 
suppressed by inhalations of iodine : 

" Mrs. McL , aged seventy years, had suffered for several 
months with cough, constipation, and oedema of the feet and legs, 
with incontinence of urine. She complained especially of exces- 
sive expectoration, which had reduced her almost to a skeleton, 
and it was with difficulty she could walk across the room. I did 
not see the matter expectorated, which was so offensive that she 
declined saving it, but both she and her daughter estimated the 
quantity latterly at a pint to a pint and a half every morning, for 
it was only in the morning that her cough troubled her. Begin- 
ning at three to four o'clock, it continued several hours, during 
which time the expectoration was free and profuse ; and she often 
passed the remainder of the day without coughing at all. 

" I guve her an inhaling-tube, charged with iodine, to be used 
frequently during the day and night, and directed her to take 
one-tenth of a grain of arsenious acid three times a day, together 

* Am. Jour, Med. ScL, Jan. 1866. 



AIRS, GASES, VAPORS, AND FUMES. 109 

with half a grain of calomel at night. This course was continued 
twenty days with progressive improvement, when (June, 1867) 
she was entirely relieved of the bronchial disease, and the iodine 
inhalations were suspended." 

Inhalations of iodine have been recommended in diph- 
theria by Dr. J. Waring Curran.* His formula con- 
sists of a grain each of pure iodine and iodide of potas- 
sium, with one drachm of alcohol in an ounce of dis- 
tilled water. One drachm, gradually increased to four, 
is added to a pint of vinegar, in which a handful of 
dried sage has been infused. The inhalation is kept up 
for from eight to twelve minutes, the temperature being 
maintained equable by a spirit-lamp ; and it is repeated 
every two hours. 

Whitelaw has recommended inhalations of iodine in 
fetid breath. f 

Leigh rubbed iodine ointment upon the chest and 
into the axillae, so that the patient could breathe the 
vapor by placing his head beneath the bed coverings. J 

It must not be overlooked, in considering this sub- 
ject, that much of the benefit derived from painting 
tincture of iodine, and the like, over portions of the 
chest in cases of pulmonary phthisis, chronic bronchitis, 
etc., may be justly attributed to inhalation of the vapor 
of the iodine thus employed. This is especially prob- 
able in cases in which the iodine is applied at night. 

I have had considerable satisfactory personal experi- 
ence in treating the chronic laryngitis of tuberculosis 
with inhalations of iodine in combination with carbolic 

* The Lancet, Sept., Oct., 1867, pp. 357, 513; 1868, October 
16th, No. 17. 

f Med. Times and G-az., Oct. 1st, 1870. 
J London Med. Gaz., xxviii, p. 394. 

10 



110 THE INHALATION OF 

acid, a grain or two of the latter, with ten or more drops 
of the compound iodine water or tincture of iodine, 
thrown upon hot water in any convenient vessel or in- 
haler, and repeating the inhalations once or twice in 
the day for from five to ten minutes at a time. 

Iodoform. 

Iodoform, dissolved in ether, was recommended by 
Righini as of great service in retarding the progress of 
phthisis.* I am not aware of any further application 
of the remedy by inhalation. 

Bromine. 

Bromine vapors by inhalation have been recom- 
mended in croup and diphtheria. Leuthlenf employed 
in croup a solution of four parts each of bromine and 
bromide of potassium in two hundred parts of distilled 
water. A sponge saturated in this solution is held 
under the nose of the patient for from five to ten min- 
utes every hour. SchutzJ also recommends it in croup 
aud diphtheria. He employs the same formula, placing 
the sponge in a cone of drawing-paper and holding it 
over the mouth and nose as in chloroformization ; the 
inhalation continuing from five to ten minutes, and 
being repeated every hour or half hour. 

Gottwald§ reports two cases of croup, in which trach- 

* (Jour.de cliim. med., February, 1853; Assoc. Med. Jour., 
April 1st, 1853) ; Am. Jour. Med. Sci., July, 1853, p. 192. 

f Wiirtemburg Correspbl. 39, 1864; Waldenburg, op. cit., p. 
683. 

X ( Ueber einige Krankheiten der Halspartie, Prag. 1865 ; 
Wiener Wochenschr, 33ff., 1871), ibid. 

I (Deutsche Klinik, 18, 1872), ibid. 



AIRS, GASES, VAPORS, AND FUMES. Ill 

eotomy was indicated, cured in this manner, without the 
operation ; fourteen cases of recovery of diphtheria of 
" the fauces," and four deaths in complicated diphtheria. 

Dr. Ch. Ozanam reports remarkable success (recovery 
in all but four or five out of one hundred and fifty 
cases) with bromine by stomach and air-passages in 
membranous croup.* He takes a bowl of boiling water 
and places over it a funnel of glass or of paper. He 
puts into the water a large pinch of bromide of potas- 
sium or of common salt, and afterwards adds gradually, 
two or three times within the space of from five to ten 
minutes, a teaspoonful of an aqueous solution of bromine 
about one drop to the ounce. The patient must inhale 
slowly and deeply the vapor, which, mixed with the 
steam of the water, does not produce any irritation. 

It is highly recommended by Dr. F. Vogelsang in 
the nervous stage of whooping-cough ; the atmosphere of 
the patient's apartment being kept impregnated with the 
vapor of bromine. f 

Sulphur. 

Sulphur vapors have been employed by inhalation 
from very early times. Their popular virtues as disin- 
fectant and antimiasmatic have been recorded by 
Homer.J Galen is well known to have recommended 
patients with various affections to frequent the vicinity 
of Mt. Vesuvius, to respire the air loaded with its sul- 

* Kev. de therap., January 1st, 1868 ; Am. Jour. Med. Sci., 
April, 1868, p. 537. 

f Memorabilien, 1874, Xo. 10 ; Brit. Med. Jour., April 17th, 
1875, p. 509. 

X (Odyssey, xxii, 481) ; Waldenburg, op. cit , p. 567 ; (Iliad, lib. 
xvi) ; Pereira, Materia Medica, Phila., 1843. 



112 THE INHALATION OF 

phurous emanations. They were also employed by 
Celsus, even in the paralysis after apoplexy. Avicenna 
employed the fumes of sulphur in asthma.* 

The manufacture of sulphuric acid, it is asserted by 
M. Baumes,f protects those employed against phthisis, 
even restoring to health those who seem to have been 
predisposed to the disease. 

Of recent years the inhalation of sulphurous acid 
vapors has again attracted attention. They are exten- 
sively employed on the continent of Europe; inhala- 
toriums being established at many of the sulphurous 
springs visited as summer and health resorts. They 
are employed in superficial inflammations of the entire 
respiratory tract generally, in phthisis, in chronic bron- 
chitis, in emphysema, asthma, and whooping-cough. 

Dr. James Dewar, J of Kirkcaldy, speaks highly of the 
benefit of using the sulphurous acid fumes in the treat- 
ment of typhoid, ephemeral, and scarlet fevers, and in 
diphtheria, gout, and rheumatism. He saturates the 
atmosphere of the patient's room with the vapor. 

Dr. W. Jackson Cummins§ also speaks highly of 
their use in the treatment of zymotic diseases, diph- 
theria, scarlatina, etc. He burns sulphur day and 
night in the room and about the house. 

The inability of certain organic germs to live in an 



* Floyer, On Asthma, London, 1717, p. 169. 

f (Maygrier, la Phthisie, Diet, des Sci. med.); Coxe, On Inha- 
lation, Philadelphia, 1845, p. 35. 

J Dublin Med. Press and Circ. ; Medical Kecord, New York, 
1866, p. 395. See also, On the Application of Sulphurous Acid, 
Gaseous and Liquid, to the Prevention, Limitation, and Cure of 
Disease; Edinburgh, Tenth Edition, 1868. 

I Dub. Quart. Jour., August, 18G9, p. 219. 



AIRS, GASES, VAPORS, AND FUMES. 113 

atmosphere of sulphurous acid gas is considered the 
means of protection in zymotic disease. 

My own experience in diphtheria, during an endemic 
some years ago, was decidedly favorable as to the pro- 
tective, and, in some instances, apparently the curative 
value of sulphurous acid fumes. In chronic bronchitis, 
on the other hand, it has been less efficacious, in my ex- 
perience, than other treatment. 

Sulphurous acid fumes may be readily evolved by 
igniting two parts of flowers of sulphur with one part of 
charcoal. Dr. Dewar* states that a very simple method 
is to put a few red cinders into a kitchen -shovel ; to 
set this upon a wooden stool upon the floor, and then to 
sprinkle " flour of sulphur " from time to time upon 
them until the room is not inconveniently filled with 
fumes. 

Ammonium. 

The vapors of ammonia and of carbonate of ammonium 
have long been employed to rouse, by their irritating 
properties, a patient in case of sudden syncope or faint- 
ing from any cause. Pure ammonia is irrespirable, but 
mingled with a large proportion of atmospheric air it 
can be utilized for inhalation. Thus vapor of ammonia 
either from water of ammonia pure, or diluted with from 
one to twenty or more parts of water, has been recom- 
mended by Harwood and others in chronic hoarseness 
and aphonia. Smeet has recommended its use in 
chronic hoarseness, especially that form following influ- 
enza, in relaxed conditions of the throat generally, in 
the early stage of tonsillitis, and in asthma. Its irri- 

* Op. cit., p. 23. 

f London Med. Gaz., April, 1843, p. 59. 



114 THE INHALATION OF 

tant influence on the raucous membrane excites a serous 
secretion which facilitates the expectoration of mucus 
and the like. On the same grounds it is of use in 
eoryza, acute and chronic. It is usually injurious, how- 
ever, in febrile and acute inflammatory affections. It is 
said to be antidotal to the vapors of bromine, prussic 
acid, and carbonic acid gas. 

The vapor of carbonate of ammonium is of great ad- 
vantage, with some subjects, in the early stage of coryza, 
precipitating copious serous secretion. It is also said to 
be abortive when resorted to promptly. 

It has also been employed with some success in asthma. 
Trousseau sometimes made this use of it, placing a 
quantity of it by the bedside of the patient. 

The vapor of ammonia has been recommended in 
croup, when asphyxia is imminent and emetics fail to act, 
by Dr. Daguillon, of Oran, who reports* four cases of 
success from its use. His plan is to take a piece of 
sponge of the size of an almond, fixed upon a piece of 
wire, and plunge it into water of ammonia until it is 
thoroughly softened. It is then carried into the pharynx, 
care being taken not to touch the tonsils, and held there 
a sufficient time for the effect of the vapor to become sen- 
sible in the countenance. A glass of water kept close 
at hand then serves for washing out the parts at the 
back of the mouth. These inspirations are repeated 
three times, with short intervals. The presence of the 
ammoniacal vapors in the larynx and bronchi immedi- 
ately determines a hypersecretion of mucosities, which 
the infant most frequently rejects by vomiting. The 

* Gaz. Hebd., 1870, No. 30; Banking's Abstract, January, 
1871, p. 65. 



AIRS, GASES, VAPORS, AND FUMES. 115 

expectoration becomes more abundant, the oppression 
diminishes, the cough and voice become less hoarse, and 
the general symptoms are relieved. 

Mr. John Grantham recommends the vapor in the 
treatment of whooping-cough.* He employs it at bed- 
time; an ounce of the water of ammonia being put in a 
gallon of boiling water, in an open pan, steam being 
evolved by the introduction of a red-hot half brick. 

The vapor of ammonia, in combination with carbolic 
acid, has been recommended by Hager in acute coryza. 
Its efficacy has been substantiated by Brandf and 
"Waldenburg.J 

Hager's formula contains one part of carbolic acid, 
three of absolute alcohol, one of caustic solution of am- 
monia, and two of distilled water. Waldenburg's formula 
is one part each of carbolic acid and alcohol, with two 
of the caustic solution of ammonia; the proportions 
being varied to suit special cases. Brand prefers to place 
a few drops of the solution on three or four folds of 
blotting-paper, which the patient places in the palm of 
his hand ; and then he inspires the vapor deeply through 
nose and mouth as long as it rises, keeping his eyes 
closed. It may, however, be inhaled from an open 
vessel. 

Ammonia, as already mentioned, is one of the prod- 
ucts of the purification of illuminating gas, employed in 
the treatment of whooping-cough. § 

Chloride of Ammonium. 
Sal-ammoniac has been recognized as a beneficial 

* Brit. Med. Jour., 1871, September 16th, p. 323. 

f Berlin klin. Woch., 1872, No. 12. 

X Op. eit., p. 657. 

$ See under head of Carburetted Hydrogen. 



116 THE INHALATION OF 

agent in the treatment of affections of the throat and 
respiratory organs, from the very earliest periods in the 
records of medicine. 

It was first employed by inhalation, according to 
Lewin, by Prof. Fuchs, of Gottingen.* In the pub- 
lished reports of the Gottingen Clinics for 1838 and 
1839, it is recorded that Prof. Fuchs employed the in- 
halation of the vapors from sal-ammoniac in the treat- 
ment of chronic catarrhs of the respiratory organs ; 
the fumes being evolved by placing the salt upon a 
heated porcelain plate. Lassegue, more recently, re- 
sorted to the same means in France, with satisfactory 
results. At a later date, the fumes from sal-ammoniac 
were highly recommended by Dr. Geiselerf in chronic 
pulmonary catarrh ; and his method of administration 
is as follows : Two or three teaspoon fu Is of the salt are 
placed in a Hessian crucible and heated over a Berzelius 
lamp, the patient sitting in front of the apparatus and 
inhaling the •vapor ; the chamber soon becomes filled 
with the fumes of sal-ammoniac, and for some time (one 
to two hours) after their disengagement has been discon- 
tinued, the invalid remains in the strongly impregnated 
atmosphere. This is repeated once or twice in the 
twenty-four hours. 

Direct inhalations give better results than breathing 
the strongly impregnated atmosphere of a room in which 
the fumes are being disengaged. Paroxysms of cough, 
with profuse expectoration, ensue only during the earlier 
sittings ; later, there results merely a sensation of warmth 
in the air-passages. 

* Schmidt's Jahrb,, 1841, xxxiii, p. 319. 
f Henle and Pfeufer's Ztschr., 1854, v. 3. 



AIRS, GASES, VAPORS, AND FUMES. 117 

Dr. Pasch* places a drachm of the caustic water of 
ammonia in a saucer, in which he places a watch-glass 
containing from one-third to one-half of a drachm of pure 
muriatic acid. White fumes of sal ammoniac are im- 
mediately evolved, and, as in other cases, may be inhaled 
with or without the use of a funnel, to direct them into 
the mouth. A great excess of ammonium is produced by 
this method, but it is not considered injurious. In the 
lungs of catarrhal patients there always remains a quan- 
tity of carbonic acid gas which is not exhaled, and 
which, remaining in the minutest bronchi, becomes con- 
verted into carbonate of ammonium as the sal ammoniac 
reaches it. 

I have often instructed patients merely to place a 
pinch of the salt upon an iron spoon, and hold it over 
the flame of a gas or spirit-lamp ; the fumes are evolved 
in a few moments, and the spoon can be removed and 
the fumes inhaled, with or without the use of a funnel, 
until evolution ceases ; w T hen the process is to be re- 
newed until the required amount has been employed. 

I have found these inhalations of extreme value in 
cases of dryness of the pharynx (pharyngitis sicca), even 
when of several years' standing, as met with in sales- 
men and others, w r hose mouths are more or less fre- 
quently open, and who, by the nature of their avocations, 
are exposed to variations of temperature ; also in the 
dryness of the pharynx in cooks, bakers, and others 
who are constantly breathing a heated atmosphere ; also 
in chronic pharyngitis ; in the commencing stage of 
bronchitis, to induce free secretion; in snuffles, naso- 

* Preuss. Vereinzeitung, 1862, 19; quoted by Lewin, op. cit., 
p. 200. 



118 THE INHALATION OF 

pharyngeal catarrhs, and the like ; in fact in all cases 
in which the object is to promote secretion or facilitate 
its detachment and expulsion. 

The best mode of administering inhalations of the 
vapor of chloride of ammonium is, without doubt, in 
the nascent state; and of all contrivances for the purpose, 
the apparatus of Lewin (p. 32) is the best. A variety 
of contrivances have been placed upon the American 
market to replace this apparatus of Lewin; more com- 
pact, in some instances, for purposes of transportation, 
but possessing no other advantage, and much less simple 
in their construction. I prefer, in some respects, the 
arrangement of Lewin's apparatus, as modified by my- 
self,* in which the external air is forced into the appa- 
ratus by means of a handball bellows, so that the vapor 
can be inhaled as it escapes, without subjecting the pa- 
tient to the effort of aspiration. 

One precaution is requisite in the use of these vapors, 
and that is not to continue them too long at a time, or 
repeat them too frequently, as they will eventually re- 
move the epithelium from the tongue and make it sore, 
especially when they are inhaled from a tubular mouth- 
piece. 

Chloroform. 

The anaesthetic uses of chloroform do not come under 
consideration in this volume. 

Chloroform is frequently employed for therapeutic 
purposes in relaxing spasms, alleviating pain, and pro- 
moting secretion from the mucous membrane of the res- 

* Diseases of the Throat, etc., New York, 1872, p. 276. 



AIRS, GASES, VAPORS, AND FUMES. 119 

piratory passages. Baumgartner,* one of the first to 
have made extensive use of inhalation of chloroform for 
therapeutic purposes, employed it chiefly in pneumo- 
nia ; but tried it also in bronchial catarrh, emphysema, 
asthma, whooping-cough, and haemoptysis. It appears to 
diminish the pain, sense of oppression, and cough, in 
pneumonia, and thus to contribute greatly to the comfort 
of the patient. Baumgiirtner's results have been con- 
firmed by many observers, some of whom, indeed, have 
found the inhalation curative in pneumonia. 

Dr. Hutawa has reportedf the happiest results in 
pneumonia from the inhalation of half a drachm or a 
drachm every hour, day and night. 

Dr. Malmsten, of Stockholm, J claimed to have cured 
two cases of pneumonia, and one case of capillary bron- 
chitis, by means of chloroform inhalations. 

In nervous and spasmodic affections of the respiratory 
organs the inhalation of chloroform is certainly often 
beneficial, and it may be resorted to with some degree 
of confidence in the spasms of whooping-cough, stridu- 
lus laryngismus, and spasmodic coughs of almost every 
nature. 

Dr. Fleetwood Churchill§ recommended these inhala- 
tions in whooping-cough as controlling the disposition to 
cough, the whoop, and the like. 

* (Neue Behandlungsweise der Lungenentziindung und ander- 
er Brustkrankheiten, nebst einer Darstellung der Abortionmeth- 
ode, Mit Beitragen von Helbing, von Kotleck, Schmidt, etc. 
Stuttgart, 1850.) Waldenburg, op. cit., p. 646. 

f (Preuss-Verein-Zeit., 11, 1855.) Am. Jour. Med, Sci., April, 
1856, p. 476. 

% (Edinb. Med. Jour., from Jour. f. Kinderheilk, 1855, Bd. 
xxiv, p. 435.) Am. Jour. Med. Sci., April, 1856, p. 477. 

I Edinb. Med. Jour., Aug., 1853; Braithewaite, 1853, p. 93. 



120 THE INHALATION OF 

Mr. G. H. Heath reported* that the excessive vomit- 
ing in cholera will sometimes be controlled by inhala- 
tions of chloroform, when nothing else will succeed ; and 
that life may in this way be saved. 

The inhalation of chloroform has been recommended 
in spasmodic croup to overcome the spasm. It has also 
been highly recommended in asthma by various observ- 
ers, one of the most distinguished among whomf con- 
sidered it one of the most powerful and speedy remedies 
in asthma; one to which he should, perhaps, give the 
first place of all. 

It is also employed to overcome the spasm in angina 
pectoris, colics, and other painful affections, without 
pushing the administration to the abolition of sensation 
or consciousness. 

The inhalation of chloroform is often of signal use in 
the early or forming stage of acute coryza, relaxing the 
nervous tension and precipitating the eliminative stage 
of free secretion or diaphoresis. As elsewhere men- 
tioned,! I have sometimes found it competent, pushed 
to anaesthesia, to avert a severe cold in the head, even in 
cases of intense pain and tension in the brow and cheeks, 
with distressful nasal dyspnoea. As a matter of course, 
it is not to be carelessly or promiscuously employed for 
this purpose; but in suitable cases, in subjects whom 
there would be no hesitation in chloroforming for the 
purpose of performing an operation in surgery, it is 
admissible in cases of intense suffering ; the more that 
chloroform administered for the relief of pain is unat- 

* The Lancet, Oct. 15th, 1853. 

f Salter; on Asthma. Philada., 1864, p. 135. 

X Diseases of the Throat, etc. New York, 1872, p. 256. 



AND FUMES. 121 

tended with as much danger as when given to prevent 
pain. 

Ether. 

The anaesthetic uses of ether do not come under con- 
sideration in this volume. 

Beddoes* mentions that Pearson, of London, recom- 
mended inhalation of ether in pulmonic phthisis, in 
which he had found it subdue the hectic, check the 
sweats, relieve the dyspnoea, deodorize the sputa, and 
facilitate expectoration. The vapor of ether was satu- 
rated with cicuta leaves, half an ounce of the latter in 
powder being kept in an ounce of the former for a week ; 
a teaspoonful or two of the impregnated fluid being in- 
haled at a time, and repeated three times a day or 
oftener, according to circumstances. f He did not recom- 
mend them as curative, but as affording very grateful 
relief, so that patients will not willingly discontinue 
their employment, after having once experienced their 
benefits. 

Inhalations of ether, impregnated with squill by the 
addition of the tincture, are recommended in asthma by 
the same authority. J 

Scudamore employed inhalations of ether in spas- 
modic asthma. 

Dr. Eberle recommended the inhalation of ethereal 
vapors in pulmonary affections. He considered them of 
very great value in relieving dyspnoea. § 

* Beddoes and Watt, Factitious Airs. 

f Morton; Illustrations of Pulmonary Consumption, Philada., 
1837, p. 246. 

% Coxe, on Medical Inhalation, Philada., 1845. 
\ Coxe, op. cit. 



122 THE INHALATION OF 

Dr. James Clarke, of London, recommended the in- 
halation of ether, or of ether holding some narcotic in 
solution, as occasionally useful in the dyspnoea of con- 
sumption, and he found (opium and) ether afford the 
most effectual relief in the last stage of the disease, 
when the oppression of breathing becomes very distress- 
ing, especially towards night.* 

Baumgartnerf employed ether as well as chloroform 
in the various affections named in our mention of the 
latter remedy. 

Dr. Physick, of Philadelphia, was in the habit of em- 
ploying the vapor from equal parts of Hoffman's ano- 
dyne and laudanum, in cases of recent catarrhs, in coryza, 
and obstinate hoarseness ; and its value in these cases is 
attested by Dr. Chapman in his work on Therapeutics. 

In the dyspnoea dependent on chronic bronchitis, 
Prof. Wood considers the inhalation of ether doubly 
useful, if carefully managed, both by relieving the dis- 
tressing sensation and favoring mucous secretion. J 

Inhalations of ether have been recommended as al- 
most an abortive in pneumonia; but Skoda states that he 
has never seen them exercise any modifying influence, 
even in the earliest stages. 

They have been highly recommended in whooping- 
cough, spasmodic asthma, and in chronic affections of 
the air-passages generally ; and it is not unlikely that 
much of the benefit arising from the inhalation of 
ethereal solutions of the balsams is due to the sulphuric 
ether. 

* A Treatise on Pulmonary Consumption, 
p. 286. 
f Op. cit. 
% Wood's Therapeutics, second edit., vol. ii, p. 697. 



VAPORS, AND FUMES. 123 

Ether, impregnated with musk, camphor, asafoetida, 
opium, and the like, is sometimes preferable to pure 
ether. 

Dr. W. Y. Gad berry, of Yazoo City, Mississippi, re- 
cords* some cases of capillary bronchitis treated effectu- 
ally with inhalations of ether. 

The same gentleman has furnished me with the fol- 
lowing notes of the effect of the same treatment in a 
case of acute bronchitis : 

" Early in the winter of 1866-67, the Kev. Mr. B— n left Lex- 
ington, Mississippi, for Cincinnati, Ohio, suffering with catarrh, 
and returned in ten days with a violent attack of bronchitis and 
diarrhoea. During the first week his fever was high, with a pulse 
ranging from 110 to 130. He complained of oppression of the chest, 
dyspnoea, and loss of sleep. After a week's trial with the reme- 
dies usually adopted in such cases, I became alarmed for the safety 
of my patient, and determined to use inhalations of sulphuric 
ether. By it the dyspnoea was immediately relieved, sleep became 
natural and refreshing, his harassing cough gradually subsided, 
and he soon recovered He took it at intervals, pro re nata." 

Dr. Gadberry informed me that he had asked this pa- 
tient his opinion of the efficacy of the ether in his case, 
some months after the treatment, and he had been 
assured by him that it had given decided and permanent 
relief. 

In a letter to Dr. Gadberry, from Dr. W. H. Williams, 

of Lexington, Kentucky, the latter gentleman writes 

under date of April 15th, 1867 : 

" During the spring of 1866, I was the subject of severe bron- 
chial catarrh, which persisted for many weeks, resisting the or- 
dinary course of treatment prescribed by adopted authorities, 
when, at your suggestion, I began the use of ethereal inhalations, 
the disease at this time having assumed a gravity well calculated 
to arouse my suspicion of approaching tuberculosis. I first used 

* Nashville Journal of Medicine and Surgery, October, 1866. 



124 THE INHALATION OF 

sulphuric ether, and it served well the purpose of relieving the 
frequent paroxysms of dyspnoea, which, though not severe, were 
extremely annoying. Subsequently I adopted the use of equal 
parts of ether and tar, and with more gratifying results than I 
had experienced from the use of ether alone. 

" The combination seems to promote a free and easy, yet not a 
copious expectoration, but on the contrary exhibits a decided ten- 
dency to overcome the hypersecretion. This, perhaps, is due to a 
sedative and antiphlogistic influence exerted by the tar-vapor upon 
the inflamed mucous membrane. I pursued this course for some 
weeks, to my entire relief." 

Dr. Samuel \V. Francis, of Newport, Rhode Island, 
has informed* me that he has employed inhalations of 
ether for a bad sore throat, to which he is subject, and 
feels confident that the inhalation not only alleviated 
the symptoms, but cured the sore throat ; and he has 
formed the opinion that we have a valuable remedy 
by this means, in the treatment of bronchitis. 

The inhalation of sulphuric ether has been recom- 
mended from various sources as a valuable remedy in 
cases of hysterical or nervous aphonia. I have myself, 
on several occasions, been able to restore the voice in 
cases of aphonia in this way, but most of the cases re- 
ferred to occurred in military practice, and I have no 
reason to believe that they were not those of malinger- 
ing in every instance. It was curious to notice in some 
of the cases, after the subjects had learned the object of 
placing them under an anaesthetic influence, how well 
they could control themselves while going under the in- 
fluence of the ether, not a sound escaping them until the 
moment of unconsciousness; but, oblivion having once 
ensued, the effect in coming to was not anticipated, or if 
anticipated, was forgotten under the anaesthetic condi- 

* Letter of March 5th, 1867. 



ATRS, GASES, VAPORS, AND FUMES. 125 

tion, and the intoxication would be evinced by the usual 
clamors, when a sudden restoration of consciousness 
would announce to them, with a moral shock, the cure 
of their aphonia. 

I have, however, succeeded in restoring the voice in 
cases of so-called nervous aphonia, by the injection of 
sulphuric ether into the larynx; but here the result was 
due to the local stimulus, rather than to the therapeutic 
effect of the ether. 

Dr. F. D. Lente, of Cold Springs, New York, records* 
a case of hysterical aphonia cured by the inhalation of 
sulphuric ether. 

" This was an unmarried female, set. 40, who had been an inva- 
lid for several years. Early in 1860 she lost her voice so that she 
could not articulate above a whisper. In December of that year 
she was placed under the influence of sulphuric ether for the re- 
duction of a strangulated femoral hernia, and twice, on recover- 
ing from the anaesthetic influence, the patient expressed her belief 
that she articulated with less effort, although she still spoke in 
whispers. Brought a third time under the influence of the ether, 
preparatory to the operation, certain attendant circumstances kept 
her under the influence of the ether for two hours, and as soon as 
she had fully recovered from its effect she exclaimed aloud, 
' Doctor, I can speak !' and her voice remained permanent up to 
the date of the report." 

Dr. Lente instances a case reported a short time pre- 
viously, in which a carman of London recovered the 
use of his voice after a deprivation of eight months, 
while under the influence of chloroform, for the purpose 
of overcoming some rigidity about the muscles of his 
jaw. 

The late Dr. L. Nordmann, of this city, wrote 
me under date of April 6th, 1867, that at Haddington 

* Am. Med. Times, April 6th, 1861, p. 224. 
11 



126 THE INHALATION OF 

U. S. A. General Hospital, he had under his charge, in 
1864, three cases of complete aphonia in United States 
soldiers, young men otherwise healthy. These men 
were not considered malingerers by himself nor by his 
colleagues. They each had made a similar statement, 
that loss of voice followed a severe cough contracted 
during prolonged exposure to wet and cold while on 
duty, some three months previous to his seeing them. 
Having heard of a case of aphonia successfully treated 
in Baltimore by inhalations of sulphuric ether, Dr. 
Nordmann determined to try the effect of the inhalation 
of ether on these cases, and as the effects of the anaes- 
thetic passed off, each, to his great surprise, had recov- 
ered the proper use of his voice. 

Dr. James H. Hutchinson, of Philadelphia, has re- 
ported a case of loss (hysterical) of speech and hearing 
successfully treated by the inhalation of ether.* 

The Montreal Gazette medicale publishes from TJ A- 
beille medicale the report of two cases of diphtheritic 
angina, or false membranous croup, treated with success 
by inhalations of ether, under charge of Dr. M. Besson : 

" The first patient was a girl six years of age, who presented 
the following symptoms : Swelling of the submaxillary glands, 
puffed face, pulse slightly accelerated, pain in the throat, difficulty 
in swallowing, mucous membrane of fauces engorged and red- 
dened, tonsils strongly tumefied, and presenting several patches of 
the pellicular exudation which characterizes diphtheritic angina. 
Voice gone ; cough dry, choking, and croupy. Respiration short, 
accelerated, and labored. The patient was at first treated in the 
usual manner, — by vomits of tartar-emetic and ipecacuanha, etc., 
chlorate of potassa, mercurial frictions around the neck, — with no 
effect, however, except the expulsion of some membranous shreds 
and patches. As a dernier ressort, Dr. B. thinking it unadvisable 

* Am. Jour. Med. Sci., April, 1861, p 412. 



AIRS, GASES, VAPORS, AND FUMES. 127 

to resort to tracheotomy, inhalations of ether were employed. 
The effect was an attack of suffocation, accompanied by a violent 
respiratory struggle, lasting nearly a minute, during which a false 
membrane, over six centimetres in length, and three millimetres 
in thickness, very dense, like a piece of parchment, was expelled. 
The effects of this paroxysm gradually subsided, and the patient 
soon went into a calm sleep. After about eight hours the symp- 
toms recurred, and again recourse was had to the ether fumiga- 
tions, resulting in further expulsion of false membranous exuda- 
tion. Calm and sleep again supervened, the croupy symptoms 
yielded, and in a few days complete recovery had taken place. 

" The second patient was a little boy, five years of age, who was 
attacked with diphtheritic angina. Vomits of sulphate of copper, 
etc., had been used, followed by the expulsion of some false mem- 
brane, but still the symptoms became aggravated. There was 
complete aphonia, tonsils tumefied, and covered with whitish 
patches; cough insonorous and choking; successive dyspnoea; 
convulsive movements of the expiratory muscles ; quick, sibilant 
inspiration; face congested; eyes injected; jugulars distended; 
extreme anxiety, convulsive agitation, and intense fever. In 
short, the patient was in the midst of these terrible paroxysms, 
which have hardly any remission, and which announce that the 
final symptoms of asphyxia are near at hand. In this condition 
the patient was made to inhale, in the space of several minutes, 
about five drachms of vaporized ether, and soon afterwards, in the 
midst of the violent efforts of a veritable strangulation, he ex- 
pelled, enveloped in thready mucosities, a false membrane, seven 
to eight centimetres long, two centimetres in its greatest circum- 
ference, and very dense. In half an hour the symptoms of ame- 
lioration had become so decided that the disease was thought to be 
broken, and during the forepart of the night the little patient 
rested quietly. Towards midnight the dyspnoea and the parox- 
ysms became again urgent and violent, so that the patient himself 
cried for the use of the ether. This second fumigation produced 
the expulsion of several pieces of false membrane, rolled upon 
themselves, but smaller than the previous one. Again, subsidence 
of the croupy symptoms, and their occasional reoccurrence during 
the next two days, when the ether was again applied. The pa- 
tient finally recovered." 

The evaporation of the ether in these cases was ac- 



128 THE INHALATION OF 

coraplished by very simple means. Placing a bottle con- 
taining the ether, and terminating in an extemporized 
tube, into a bowl of water at 40° Cent., the ether fumes 
were thus carried from the tube into the air-passages 
with the air of inspiration.* 

Dr. R. R. Livingston, of Plattsmouth, Nebraska, 
comraunicatesf the particulars of a case of laryngitis 
with exudation of lymph, treated with inhalations of 
sulphuric ether : 

"On the 4th of January, Dr. L. was called to a little girl, set. two 
years, the messenger informing him that the patient had croup, and 
was dying. Previous to his arrival the mother had administered 
a full dose of syrup of squills, and he found the patient vomiting 
and purging freely. Pulse 150; tongue slightly coated, some- 
what swollen, and red; fauces red, with an engorged appearance ; 
tonsils slightly swollen ; considerable tenderness over the larynx ; 
eyes watery; breathing slightly stridulous, the mother stating 
that previous to emesis it was very labored, or, as she expressed 
it, ' the child was choking ;' countenance expressive of great anx- 
iety ; and though no. coughing occurred at the time of the doctor's 
visit, he was informed that she had coughed repeatedly with a 
ringing, croupy cough. 

li Inhalations of lime-water were directed, as hot as could be 
borne by the child ; also one of the following powders every two 
hours, viz.: R. Hyd. chlor. mit., gr. x; antim. et pot. tart., gr. j ; 
ammoniaa hydrochlor , ^j ; M. ft. chart. No. xii.| The mother 
of the child was instructed to keep a large, open kettle of water 
boiling on the stove, for the purpose of moistening the atmos- 
phere. 

"About midnight Dr. L. received a most urgent request to 
visit the child immediately, as she was suffocating. Before enter- 
ing the chamber of the invalid, he was struck with the loud 

* Med. and Surg. Keporter, Philada., April 25th, 1866. 

f Am. Jour. Med. Sci., April, 1867, p. 376. 

J Prescriptions converting calomel into corrosive sublimate 
should be avoided theoretically, though not infrequently found 
apparently harmless in actual practice. 



AIRS, GASES, VAPORS, AND FUMES. 129 

wheezing noise of her respiration, and the peculiar loud ringing 
cough. There was great dyspnoea; respiration performed with 
difficulty; nostrils dilated; muscles of chest and neck violently 
exerted ; lips livid, and head thrown backwards, with great rest- 
lessness, and a slightly cyanosed appearance of the countenance. 
On inquiry, he was informed that the lime-water inhalations had 
afforded temporary relief, but that each time they were left off the 
difficulty of breathing recurred in a short time. 

" The parents were informed of the perilous condition of their 
child, for whose recovery tracheotomy appeared to offer the only 
hope, though with very little encouragement. At this moment," 
remembering the suggestion of Dr. Black and Dr. G-adberry, he 
proceeded to administer some of Squibb's ether by inhalation, 
according to the directions of Dr. Lente, as reported by Dr. Pack- 
ard, in the Am. Jour. Med. Sci., for January, 1866, premising the 
inhalation by the internal administration of half a teaspoonful, 
which, as anticipated, was swallowed with difficulty, and caused 
a severe paroxysm of coughing. 

"In precisely eight minutes from the time the patient com- 
menced the inhalation, the abnormal muscular exertion ceased; a 
general relaxation took place ; the pulse fell to 100, and the pecu- 
liar ' flip ' sound of partially detached membrane was distinctly 
heard during expiration ; the loud wheezing noise of the breath- 
ing abated, and in thirteen minutes the child was sleeping in 
comparative ease. In about ten minutes more she coughed, not 
with the loud, ringing, metallic sound so peculiar to this affection, 
but with the moist rale which every practitioner hails as the har- 
binger of success in the treatment of this dreadful malady. The 
coughing was followed by efforts at vomiting, and numerous por- 
tions of membrane were discharged, the edges having a whitish, 
and the centres a grayish appearance ; they were oblong in shape, 
from an eighth to three-fourths of an inch in length, and from 
half a line to a line in thickness. A few times more, at short in- 
tervals, coughing occurred, followed by emesis and the expulsion 
of additional portions of membrane. The vomiting now ceased, 
and the child slept almost naturally, the respiration being normal. 
Her sleep was frequently disturbed by short fits of coughing; but 
the intervals of rest increased in duration, and no more membrane 
was expelled, though it was evident that she occasionally swal- 
lowed portions without completely awakening. At 4 o'clock the 



130 THE INHALATION OF 

child was out of danger ; at 10 a. m. awake and playful. The re- 
covery was entire." 

In commenting on this case, Dr. Livingston acknowl- 
edges that the previous exhibition of the powders, and 
the inhalations of the nebulized lime-water, may render 
it doubtful whether the recovery was entirely due to the 
inhalation of the ether ; and, suggesting that the spray of 
the lime-water is in great measure carbonated by inhala- 
tion and thus rendered inoperative, he attributes the tem- 
porary relief afforded by its administration to the warm 
moisture of the water. But as there was no evidence of 
permanent relief until the administration of ether by 
inhalation, and the favorable effect of the latter was 
rapidly produced under his direct observation, he has 
no hesitancy whatever in ascribing the recovery to the 
ether. 

Dr. W. Y. Gadberry, of Yazoo City, Mississippi, has 
furnished me the following notes of a case of croup 
treated by inhalations of sulphuric ether : 

" On the night of the loth of April, 1867, I was called, in the 

absence of the attending physician, to see a child of Mr. M , 

set. eight months. When I arrived the child was in imminent 
danger of dying from nonplastic croup. It had been relieved on 
the night previous with emetics of alum and lobelia, and cold ap- 
plications to the throat. The fever, however, continued up to the 
time of my visit. I ordered an alum emetic, which acted promptly ; 
applied turpentine and hot flannels to the throat, and a snuff 
plaster to the chest. In the course of half an hour the symptoms 
improved some little, but not enough to justify my departure, or 
any assurance of permanent relief. I then resorted to inhalations 
of sulphuric ether, which gave complete relief in five minutes to 
all the difficulty of respiration ; nor did it return any more. To 
relieve the febrile excitement I directed hyd. cum creta, to be re- 
peated until it acted on the bowels." 

My own experience with inhalations of ether in croup, 



AIRS, GASES, VAPORS, AND FUMES. 131 

limited, however, to a few experimental attempts, has 
not been confirmative of the successes reported by others. 
Very little has been heard of this method of treatment 
since the first edition of this volume. 

A combination of ether, sixty parts; chloroform, thirty 
parts, and turpentine, one part, has been recommended 
in whooping-cough by Dr. Wild,* who claims that he can 
cure every case within eight days, by confining the 
patient to his room, and making him, at every access of 
coughing, place before his mouth a small piece of cloth, 
folded several times, and wet with a teaspoonful of the 
solution. 

NlTHITE OF AMYL. 

The introduction of nitrite of amyl into therapeutics 
is due to Dr. Brunton, who first employed it in angina 
pectoris ;f in which complaint he found it more effica- 
cious than any other remedy. His experience has been 
confirmed by Anstie, Talfourd Jones, and others, in Great 
Britain, and by S. Weir Mitchell and others, in the 
United States, who have also found it useful in relieving 
the paroxysmal dyspnoea of asthma, in neuralgias, especi- 
ally those of the fifth pair of nerves, and in abating the 
paroxysms of convulsions in epilepsy,j and in tetanus. § 
I have occasionally resorted to it in spasm of the larynx, 
whether due to disease or excited by the direct applica- 
tion of remedial agents, and have found it efficacious in 
relaxing the spasm ; and I can repeat the observation with 

* American Practitioner, May, 1875. 

f The Lancet, 1867, 11, p. 97. 

% S. Weir Mitchell, Philada. Med. Times, April, 1872; Trans. 
Coll. Phys., Philada ,1875, p. 107. 

I See, particularly, Forbes, Trans. Coll. Phys., Philada., 1875, 
p. 121. 



132 THE INHALATION OF 

regard to paroxysms of nervous asthma. It has been 
recommended in whooping-cough, and in spasm of the 
stomach. In fact, it appears to be a relaxer of spasm 
generally. 

It is usually administered by pouring from two to ten 
drops upon a handkerchief, according to the suscepti- 
bility of the individual, — a susceptibility which de- 
creases with its repeated use, — and inhaling the vapor 
until the characteristic effect is produced, which is visible 
in from thirty to sixty seconds, and is manifested in 
suffusion of the face and neck, with varying increase in 
the frequency and force of the pulse, as exhibited in the 
carotids and the action of the heart. Dr. Brunton's inves- 
tigations show that it relaxes the arterial system gener- 
ally ; and this is attributed to partial paralysis of the 
sympathetic ganglia and the motor nerves. When in- 
haled under unconsciousness, it exhibits a specific action 
on the motor centres of the mouth, manifested by yawn- 
ing, etc.* 

The flushing of the face induced by this agent sug- 
gested its use in facial neuralgia associated with anaemia ;f 
and experience seems to indicate that larger doses are 
borne in anaemic patients than in others. 

The use of this agent requires caution, though it does 
not appear to be as dangerous a remedy as it was sup- 
posed to be in the earlier essays of its therapeutic appli- 
cation. 

Dr. Rufus R. HintonJ reports a few cases of the suc- 
cessful use of inhalations of the nitrite in hysterical 



* J. Crichton Browne, The Practitioner, Sept., 1874, p. 179. 
f Dr. Geo. H. Evans, ibid., Sept., 1875, p. 178. 
I Phila. Med. Times, July 31st, 1875, p. 694. 



AIRS, GASES, VAPORS, AND FUMES. 133 

convulsions, the cold stage of inter mitten ts, and chloro- 
form-narcosis. 

Dr. Crochley Clapham recommends the use of this 
agent in sea-sickness, after considerable experience of its 
utility.* He poured three drops on a handkerchief, and 
held it close to the patient's nose, so as to impede too free 
admixture of atmospheric air. In 121 cases out of 124 
there was no return of vomiting after the administration 
of the nitrite, and its use was only unsatisfactory in the 
remainder, in so far that they required a further dose or 
two of the remedy. 

Inhalation of nitrite of amyl was suggested by Dr. 
F. A. Burrall, of New York,f in threatened syncope 
from chloroform ; and quite recently Mr. C. Bader, of 
London,j has reported a few cases of the kind in which 
the inhalation of the nitrite appears to have accom- 
plished the expected result. 

Balsamic Vapoes. 

The custom of sending patients with pulmonary com- 
plaints to localities where they might constantly breathe 
the balsamic atmosphere produced by the vegetations of 
aromatic plants, is of very old origin, dating at least 
from Rhazes in the ninth century ; and the direct use 
of balsamic inhalations is attributed to Galen, Ascle- 
piades, and Dioscorides. 

In the middle of the seventeenth century Dr. Bennet, 
of London, employed artificial balsamic atmospheres by 

* The Lancet, Aug. 21st, 1875, p. 276. 

f (N. T. Med. Gaz., June 11th, 1870); Am. Jour. Med Sci., 
July, 1875, p. 233. 
j (The Lancet, May 8th, 1875), ibid. 

12 



134 THE INHALATION OF 

fumigations of frankincense, styrax, ammoniacum, and 
turpentine, with coltsfoot, cinnamon, and the like, in 
powder, or made into troches and burned upon coals. 
He also employed the vapors evolved by pouring boil- 
ing water upon various mixtures of herbs.* 

These vapors were much used by Mead and others, 
and are recommended, among other inhalations, as pro- 
motive of secretion, by Dr. Tweedie, in his- treatise on 
Diseases of the Respiratory Organs. 

Balsamic inhalations at one time attracted a great 
deal of attention in continental Europe. They were 
recommended in the treatment of chronic pulmonary 
catarrhs, and obstinate cases of chronic laryngitis, espe- 
cially when connected with ulceration, by Delpit, Rul- 
lier, Maygrier, Martin Solon, and many others ; and by 
none more strongly than by Trousseau and Pidoux. 
Trousseau and Pidoux preferred to throw some of the 
balsam upon live coals, rather than to pour boiling 
water upon some of the material in an inhaler ; because, 
by the former method, the apartment becomes filled 
with the vapor, and the patient can remain for whole 
days in an atmosphere thus impregnated. They state 
that chronic catarrhs have been cured in this manner, 
after failure with the same remedies used internally. 

These inhalations were found valuable in phthisis, as 
a means of conserving strength, and thus prolonging life. 
The balsams most constantly employed were benzoin 
and balsam of Tolu, the latter more frequently ; and the 
balsam of Peru was also occasionally employed in the 
same way. 

Inhalation of an ethereal solution of Tolu has been 

* Copland's Diet. 






AIRS, GASES, VAPORS, AND FUMES. 185 

successfully employed by M. Roziere in cases of bron- 
chial catarrh, loss of voice, and chronic affections of the 
chest generally. His plan is to mix twenty grammes of 
the balsam with sixty grammes of sulphuric ether ; the 
mixture to be placed in a wide-mouthed bottle, which 
the patient holds, uncorked, to his nose for two or three 
minutes every half hour. 

As, however, the inhalation of sulphuric ether alone, 
as m'entioned previously, is very highly recommended 
in these very affections, it is not improbable that much 
of the beneficial effect of the ethereal solution of Tolu is 
attributable to the menstruum. 

Benzoin, in the form of the compound tincture, is an 
excellent sedative in many catarrhal inflammatory lesions 
of the pharynx and upper air-passages, whether primary 
or supervening as exacerbations of chronic conditions. 
A drachm of the tincture may be thrown upon a pint of 
hot water, and inhaled for from five to ten minutes 
every few hours. 

To employ the balsams with the ordinary inhaler, 
boiling water may be poured upon one or two drachms 
of the drug. 

The balsam of copaiba was much used in inhalation 
by Dr. Edward J. Coxe,* of Baltimore, in the treat- 
ment of chronic laryngeal and bronchial affections; and 
deserves more attention than has hitherto been paid to it. 

Lewin| reproduces an interesting account of the 
method of inhalation pursued by the Persians, as nar- 
rated by Dr. Polak, physician to the Shah. This con- 
sists in smoking the fumes of certain medicinal agents 

* Op. cit. 

t Op. cit., p. 209, from the Allg. med. Central Zeitung, 1863, 
No. 23. 



136 THE INHALATION OF 

through their narghile, a smoking apparatus, by means 
of which the smoke passes through a vessel containing 
cold water, before it reaches the mouth. The material 
to be employed medicinally is mixed with their smoking 
tobacco, which is made into moistened masses and in- 
serted into the plaster bowl of the narghile, and then 
covered with burning coals. The material is slowly con- 
sumed, and the smoke in passing through the cold water 
receptacle is not only cooled, but also deprived of a 
portion of its narcotic or other properties. 

In cases of chronic catarrh and bronchitis, Dr. Polak 
employed gum ammoniac, gum galbanum, etc. ; in spas- 
modic and hysterical affections, assafcetida ; in ischias, 
turpentine with pistachia lentiscus, or mastic, with good 
results, or at least without injurious effect. In addition, 
they could employ quinine, salicine, even narcotine and 
digitalis; and many mineral substances, as borax, sal 
ammoniac, and the like. 

By smoking the tobacco, a condition of relaxation can 
be induced, advantage of which may be taken, the same 
as the narcosis from chloroform, for the reduction of lux- 
ations, the reposition of hernias, etc. The plant tombak 
employed by the Orientals, is one of the Nicotianse, and 
very similar to our own tobacco ; it has a red leaf, 
grows favorably in sandy soils, etc., etc. 

Eesinous Vapors of the Coniferje. 

Dr. W. W. Ireland,* had already made the observa- 
tion that in pine forests the quantity of ozone in the air 
was increased by their resinous emanations, which con- 
tained, if not ozone itself, at least a substance possessing 

* Edinburgh Medical Journal, Feb. 1864; British and Foreign 
Med.-Chir. Review, July, 1864, p. 250. 



AIRS, GASES, VAPORS, AND FUMES. 137 

many of its properties. He records some practical ob- 
servations made at a little town called Die, in the south 
of France, on the therapeutic effect of resinous vapors. 
This kind of treatment was in popular use among the 
mountains of Dauphine* for more than a century, and 
was discovered by accident. Some laborers were cutting 
wood for preparing pitch, when one of them was sud- 
denly seized with acute rheumatism in the legs, which 
disabled him from the more active work, but allowed 
him to arrange the cut wood in the furnace. After 
working a little time at this employment, which exposed 
him to the resinous vapors from the wood, he felt his 
complaint gradually disappearing; and the cure thus 
effected became known among the peasantry, and sub- 
sequently attracted more particular attention. 

Dr. Chevandier, finding that the peasants suffering 
from rheumatism exposed themselves to the vapors of a 
pitch furnace, and thus became cured of their com- 
plaints, examined the subject in a scientific manner. He 
found that the peasants had been in the habit of sitting 
in the furnace at a heat of nearly 190° Fahrenheit, and 
his own experience showed that in an atmosphere satu- 
rated with turpentine vapors, this very high temperature 
was not only tolerable, but pleasant; and he himself en- 
tered the furnace to study its physiological effects. He 
found that the skin perspired freely, the pulse rose, and 
his sensations were agreeable. 

Since these experiments were made, some baths have 
been used at Die, constructed on the same principle as the 
pitch furnace. They resemble large baking-ovens, the 
fire being below; the resinous layers of pine wood are 
strewed upon the floor, and the patient sits upon a bench, 
wrapped in a porous covering of wool. 



138 THE INHALATION OF 

The temperature to which the patients are exposed is 
generally from 140° to 158° Fahr., and they remain 
in the atmosphere from fifteen to twenty minutes. The 
sensations of the patients are agreeable, the perspiration 
is abundant, the pulse rises from twelve to fifteen beats, 
and the respiration is accelerated at first. After the 
proper period has expired, the patient goes to bed, where 
he remains an hour or two. 

The diseases treated by this plan are : rheumatism in 
all its forms ; inflammation of mucous surfaces, as chronic 
bronchitis and laryngitis; neuralgia; glandular enlarge- 
ments; and constitutional syphilis. Nine-tenths of the 
patients who resort to Die suffer from rheumatism, the 
muscular form yielding more readily than any other, 
but articular rheumatism yielding more slowly. Next 
to rheumatism, chronic bronchitis appears to be the 
malady most benefited by this treatment, probably from 
the effects of the vapor on the diseased mucous mem- 
brane. Several cases of phthisis are also said to have 
been successfully treated by courses of twenty baths ; but 
most of the cases were in the first stage. 

Pectoral complaints, it is said, never occur primarily 
among those who work in turpentine, and in the south 
of France it is known that these maladies, and rheuma- 
tism likewise, are comparatively rare among the inhabit- 
ants of districts covered by pine forests ; and hence it 
would appear that the resinous vapors possess some im- 
portant therapeutic properties in these affections. 

Dr. Ireland suggests that the beneficial effects may be 
due to the influence of ozone or antozone upon the blood. 
Hence, fumigations of the resinous layers of fresh pine 
wood, or oil of turpentine, may be beneficial in phthisis. 



AIRS, GASES, VAPORS, AND FUMES. lo9 

The patient may live in a room or conservatory filled 
with saplings of pine, and thus reap similar benefit. 

Baths, like those used at Die, have been attempted in 
other places, as at Grenoble, Valence, and near Vau- 
cluse, but the wood the inhabitants employ is said not 
to be the same; and Dr. Ireland recommends patients 
laboring under obstinate rheumatism or bronchitis to go 
to Die, which is reached by a diligence, starting from 
the railway station at Valence. Die is a small town, 
situated in a beautiful valley among the Alps of Dau- 
phine, the lofty peaks of which guard it from the mis- 
tral, while its elevated situation saves it from the scorch- 
ing heat of the summer of the South. 

Inhalations of the vapors of resin have been employed 
under the same circumstances as the vapors of tar, tur- 
pentine, creasote, and the like; and the well-known effect 
of such inhalations has prompted the practice, which is 
of very ancient origin, of sending patients affected with 
phthisis and other chronic pulmonary affections, for tem- 
porary or permanent residence, to regions in which pine 
forests abound. 

The fumes from burning undressed wool have also 
been recommended in cases of chronic laryngitis and 
bronchitis, and they have likewise, it is said, proved 
advantageous in phthisis. 

It may be remarked in connection, that the assertion 
has been made, by Simpson and others, that young per- 
sons employed in wool factories are exempt from phthis- 
is, in consequence of their constant exposure to the inha- 
lation of oil, which is used in large quantities in such 
factories. 

Tar. 

The inhalation of vapors of tar was recommended in 



140 THE INHALATION OF 

pectoral complaints by Dr. Rush, of Philadelphia, in 
1787. The plan pursued by this distinguished phy- 
sician was to boil together equal parts of tar, bran, and 
water.* Beddoes alsof records a case communicated to 
him, in which exposure to the emanations from tar in a 
warehouse was of great benefit in a case of confirmed 
phthisis. It is to Sir Alexander Crichton,J physician 
to the Empress of Russia, however, to whom the pro- 
fession is chiefly indebted for a recognition of the thera- 
peutic uses of this remedy, the discovery of which he 
attributes to accident, and which he was induced to try 
by a conjecture of Madge, that the salutary effect of sea- 
voyages is greatly assisted by the inhalation of an atmos- 
phere impregnated with the volatile parts of the resinous 
and terebinthinate substances used aboard sailing vessels. § 

The tar recommended by Sir Alexander Crichton is 
that used for the cordage of ships, to every pound of 
which he advises the addition of half an ounce of the 
subcarbonate of potassa, in order to neutralize the pyro- 
ligneous acid.|| 

He placed the vessel containing the tar over a spirit- 

* Morton, Illustrations of Pulmonary Consumption, Philada., 
1837, p. 245. 

f Considerations on the Factitious Airs, etc. 

J An Account of some Experiments made with the Yapor of 
Boiling Tar, in the Cure of Pulmonary Consumption; Peters- 
burg and London, 1817. Practical Observations on the Treatment 
and Cure of Several Varieties of Pulmonary Consumption, and on 
the Effects of the Vapor of Boiling Tar in that Disease; London, 
1823. 

$ Clarke, op. cit., p. 274. 

|| Prof. Chapman, of Philadelphia, found benefit from the 
fumes of concentrated pyroligneous acid in foul ulcerations of the 
throat and nostrils. (Therapeutics, vol. ii, p. 36.) 



AIRS, GASES, VAPORS, AND FUMES. 141 

lamp, taking care that it should boil slowly and not 
burn ; the tar being renewed every three hours, so as to 
keep the apartment impregnated with the vapor night 
and day. The vessel must by cleansed daily to prevent 
the incineration and decomposition of the residuum, 
the effect of which is irritating. 

These fumigations did not constitute the entire treat- 
ment; other remedies being employed as deemed ad- 
visable. 

Crichton often found it useful to evolve the vapor of 
water at the same time; to which end he diluted the tar 
with more or less spring water. As long as the tar remains 
fluid, it may be used again and again ; but as soon as it 
becomes viscid it must be renewed. The first effect of 
these inhalations is slight headache, some little shortness 
of breath, and slight increase of expectoration ; the lat- 
ter being considered a favorable indication for continu- 
ance of the treatment. Increased dryness of secretion, 
on the other hand, is a contraindication. As soon, 
however, as there is any evidence of inflammatory action 
from the fumigation, the treatment is to be suspended 
for obvious reasons. 

Crichton recommended these inhalations in pulmo- 
nary phthisis, even in its colliquative stage, in the first 
stage of laryngeal phthisis, in chronic bronchitis, and in 
pulmonic blennorrhoea. 

Dr. Mackintosh* recommended the inhalation of the 
vapors of tar in chronic uncomplicated bronchitis. Dr. 
Eberlef recommended the fumes of tar in whooping- 
cough. Dr. M. Baillie, of London, attests the value of 
inhalations of vapors of boiling tar and vinegar, in ton- 

* Practice of Physic. f Mat. Med., Philada. 



142 THE INHALATION OF 

sillitis, and similar affections. Dr. Morton,* of Phila- 
delphia, employed inhalation of tar vapor extensively as 
a palliative in consumption, and knew no treatment 
that could vie with it in chronic catarrh, especially when 
attended with ulceration of the mucous membrane ; and 
he states that the same remark will apply to those mor- 
bid conditions left by pneumonia and pleurisy, especially 
when accompanied with purulent expectoration and 
dyspnoea. 

Prof. Woodf has witnessed the happiest effects from 
the vapors of tar, when continued for months, in very 
threatening chronic pulmonary disease. 

I have frequently seen benefit from the vapors of tar 
in cases of advanced phthisis, and in chronic bronchitis, 
where, if it has no other local influence, it at least re- 
duces the irritability of the mucous membrane, checks 
hypersecretion to some extent, and facilitates expecto- 
ration ; thus conserving the powers of the patient. In 
recent inflammations, and in the hectic fever of phthisis, 
its use requires caution, as it has been said to induce 
congestion, and may thus give rise to haemorrhage or 
severe inflammation. Similar caution is to be observed 
in cases with irritable cough. 

Dr. Somerville OliverJ has suggested the use of fresh 
oakum, as a substitute for tar, the oakum being intro- 
duced into a sort of net or respirator. 

The use of tar vapors in phthisis deserves to be fully 
and systematically studied, so that safe indications may 
be laid down as to the character of cases to which it is 
most applicable. The slow torpid cases of chronic phthisis, 

* Op. cit., p. 245. 

f Therapeutics, etc., 2d ed., vol. i, p. 78. 

X An Oakum Respirator; The Lancet, July 8th, 1871, p. 45. 



AIRS, GASES, VAPORS, AND FUMES. 143 

in which there is little disposition to acute exacerbation, 
seem to be those in which most benefit is to be expected. 
It should be employed cautiously, and in but moderate 
quantity at first, under all other circumstances ; and in- 
creased gradually if it acts well, or if it does not act 
injuriously. 

An iron saucepan upon the fire or over a gas flame, 
with a tin cover terminating in an elbow of piping, such 
as is used for rain spouts, forms an apparatus for evolving 
tar vapor, which can readily be arranged by a tinsmith 
at short notice; the efficacy of which I have availed my- 
self of in my own practice. The tar (prepared tar is the 
best) is mixed with water until it is soft, and a few 
ounces are placed in the pot, which is then filled with 
water and covered. The fumes, as they arise with the 
warm vapor of water, are directed into the room by the 
elbow of piping, which should be long enough to give 
sufficient direction to the vapor. 

While this volume was in press, Dr. William K. 
Dunton, of Germantown, called my attention to a very 
simple and inexpensive apparatus for the direct inhala- 
tion of tar vapor, long used by physicians in that section 
of our city, though he was unable to inform me by 
whom it was devised. It consists of a tin cup of the 
capacity of a pint, in which warm water is placed; a tin 
reservoir fits tightly into the cup, but does not reach to 
within one-third of the bottom ; into this reservoir a 
small quantity of tar is placed; and this reservoir is 
covered with a tight-fitting lid, with two holes for the 
entrance of air, and a central opening, from which a 
rectangular tube rises, terminating in a funnel-shaped 
orifice, so compressed from side to side at its upper por- 
tion that it fits very nicely over the mouth and nose. 



144 THE INHALATION OF 

The cup is placed upon the fire until the vapor is given 
off, and is then held by the patient in front of his mouth 
and nose. The apparatus can likewise be used for the 
generation of other vapors. 

Oil of Turpentine. 

Vapors from oil of turpentine were first used thera- 
peutically by Sir Alexander Crichton. It has been sup- 
posed that much of the value of external applications of 
oil of turpentine in pectoral complaints is due to inha- 
lation of the vapor. Whooping-cough, asthma, bron- 
chitis, and even croup have been treated satisfactorily in 
this manner. 

Stokes* has expressed his disapproval of inhalations of 
turpentine in the strongest of terms, and states that he 
has known several cases where a chronic bronchitis was 
converted into an acute, and, as might be expected, fatal 
pneumonia, by the use of the turpentine inhalations. 
At the same time this author recommends in the warm- 
est of termsf the daily sponging of a large surface of the 
chest with a liniment composed of turpentine and acetic 
acid, not only in bronchitis, but even in confirmed 
phthisis, for the very reason, chiefly, that he believes 
that the ingredients are absorbed by the surface, so as to 
act on the mucous membrane as distinct stimuli. The 
formula for this famous Stokes's liniment, which, more 
or less modified, I have often found of use in chronic 
bronchitis, and in mild asthma, — chiefly, I believe, from 
inhalation of the vapor which emanates from the pa- 
tient's body, especially at night in bed, — is as follows : 

* Diseases of the Chest, Philada. Ed., 1837, p. 81. 
f Op. cit., p 82. 



AIRS, GASES, VAPORS, AND FUMES. 145 

Spts. terebinth., f§iij ; acid, acet., f§ss. ; vitell. ovi, No. j ; 
aq. rosar., foiiss. ; ol. limonis, f5j- M. It is similar to 
the famous liniment of St. John Long, which, however, 
contained pyroligneous acid instead of the acetic acid. 

Ramadge* employed turpentine among other inha- 
lations ; but he attributed most of the benefit derived 
from the inhalation to the concurrent gymnastic exercise 
of the chest and its contents. 

Snowf found turpentine inhalations useful in allevi- 
ating the cough of phthisis. 

The chief remedial employment of vapors of turpen- 
tine, however, has been in cases of pulmonary gangrene, 
to correct fetor and stimulate the cavities. They have 
likewise found use in putrid bronchitis. Their utilization 
in this direction is chiefly due to Prof. Skoda, who has 
repeatedly treated gangrene of the lung successfully by 
turpentine inhalations. His plan is as follows : The 
essence of turpentine is poured upon boiling water, and 
the patient is directed to inhale the vapor arising there- 
from for fifteen minutes every two hours. Sulphate of 
quinia is also administered in the usual doses. Four 
cases are reported. J 

" The first case was that of a servant affected with limited gan- 
grene of the superior lobe of the right lung. After six weeks of 
this treatment, it became impossible to detect either infiltration or 
gangrene of the organ. On the contrary, the respiratory murmur 
had returned over the whole region. Three months afterwards 
the patient was seen in good health. 

" In the second case, an innkeeper, of mature age and strong con- 
stitution, became the subject of a gangrenous cavity in the lower 

* Consumption Curable, etc., London, 1838. 
f London Med. Jour., Feb. 1851. 

% Medical Times and Gazette, April 15th, 1853 ; and Zeitschr. 
fur K. K. Geselsch. der Aerzte zu VVien., 1853, t. ix, p. 445. 



146 THE INHALATION OF 

lobe of the right lung, consequent upon disease commencing 
March 11th, 1852. On March 21st the patient began with the in- 
halations of the vapor of turpentine; he continued, without re- 
pugnance, for five or ten minutes every two hours, taking, at the 
same time, the usual doses of quinia. At the end of three weeks 
the expectoration, which had been extremely abundant (a pint 
and a half daily), became reduced to a quarter of a pint. The in- 
spirations had been employed lour times a day. At the end of six 
weeks the patient could quit his bed. His strength was returning, 
the appetite was improving, and his general aspect was favorable ; 
but the expectoration continued to be fetid from time to time, and 
always sanious. The right side of the chest was painful and res- 
piration was labored, but the air entered the circumference of the 
lower lobe; the respiration being uncertain, and accompanied by 
feeble rales and sibilance. The patient went into the country, 
where he continued the turpentine inspirations twice a day up to 
the middle of July, by which time both cough and expectoration 
had entirely disappeared. In the month of December, 1852, he 
came to M. Skoda for a certificate of health. There was no pain, 
nor oppression, nor cough. He had recovered his embonpoint and 
his strength ; there was no retraction of the thorax ; vesicular res- 
piration was audible everywhere. 

" In the third case it was not in the Professor's power to persist 
in the treatment. 

" The fourth case was still under treatment. A butcher, of 
strong constitution, had a gangrenous cavity in the inferior lobe 
of the left lung. He fell ill about the end of May, 1852. The 
inspirations of turpentine were commenced June 4th. At the end 
of a week the fetid expectoration, which daily equalled two pints, 
had entirely disappeared, and the patient considered himself well, 
because the pain and the oppression in breathing had diminished, 
the appetite had returned, and the sleep had become tranquil. He 
therefore left off inhaling the turpentine, which was extremely dis- 
agreeable to him. On June 19th there came on a severe shivering 
fit, with cough and dyspnoea .; and during the following night the 
patient expectorated several pints of extremely fetid sanies of 
dirty-brown color. The inspirations were recommenced, but the 
patient used them as little as possible, on account of the irritation 
which they produced in the air-passages. In eight days the quan- 
tity of matter brought up had greatly diminished, and the pulse 
was normal ; but there was pain in the chest. The patient lay im- 



AIRS, GASES, VAPORS, AND FUMES. 147 

movable upon his back in a state of great weakness and prostra- 
tion ; there was no appetite. The lower lobe of the left lung was 
impervious to air. The inspirations were again suspended, but 
again recommenced on account of recurrence of the bad symp- 
toms, the disagreeable odor of the turpentine being partly rectified 
by a few drops of the essence of rose. About the middle of Octo- 
ber he was able to go into the country, having recovered strength 
sufficient to leave his bed ; nevertheless, there remained a sense of 
oppression and pain under the left scapula. At the end of Janu- 
ary he considered himself well. There was a sudden expectoration 
of two ounces of blood, after a slight fit of coughing, on February 
10th, probably proceeding from the callous walls of a former gan- 
grenous cavity; but there were no signs of further infiltration, and 
the case seemed likely to terminate well."* 

Since this period the inhalation of vapors of turpen- 
tine has been generally adopted as the best method of 
treating pulmonary gangrene. 

Skoda subsequently employed this treatment success- 
fully, not only in pulmonary gangrene, but also in tra- 
cheal and laryngeal catarrh, in paralytic aphonia, and in 
pulmonic phthisis. f 

These inhalations have been recommended by Nie- 
meyer in chronic pulmonic catarrh with emphysema. 

They have also been recommended in whooping-cough,;]; 
in which disease they diminish the intensity of the par- 
oxysm, rather than shorten the duration of the malady 
or the frequency of the cough. 

Beigel has extolled them in catarrh. § 

Vapors of turpentine are said to be prophylactic 

* Banking's Abstract, 1854, vol. 18, p. 69; Am. Jour. Med. 
Sci., Oct. 1854, p. 527. 

f Allg. Wien. med. Ztg., 1862, Nos. 16, 24, 26, 29, 31. 

X Jahrb. f. Kinderheilk., 1860, p. 255; Schmidt's Jahrb., 1866, 
Bd. 130, p. 63. 

I The Lancet, 1867, p. 512. 



148 THE INHALATION OF 

against poisoning in the manufacture of phosphoric 
matches.* 

Traube, who frequently employed these inhalations 
successfully, cautions against exciting inflammations in 
their use.f 

I have found them very useful in some cases of chronic 
bronchitis, and in the chronic laryngitis of phthisis. 

The vapors of oil of turpentine may be evolved by 
putting from twenty drops to a drachm upon an ounce 
of water and applying heat; or, as I have frequently 
done, a drachm may be rubbed up in three or more 
ounces of water with half a drachm of carbonate of mag- 
nesium, and a drachm or more of the mixture be thrown 
upon hot water. 

Oils of Pine. 

The oils of pine are often substituted for the oil of 
turpentine, on account of their less disagreeable odor. 
Several oils of pine are used for the purpose, according 
to convenience in procuring them, but that prepared 
from the Scotch fir tree (oleum pini sylvestris) seems to 
be in greatest favor. They answer the indication in 
most instances, but their effect is less active than that of 
turpentine. 

LewinJ speaks of the use of the oil of mountain pine 
(pumelion), with a few drops of which he saturates a 
small piece of cotton, which is then placed in the bowl 
of a small smoking-pipe, through which the patient 
inspires for several hours at a time. This oil, he states, 

* Bellini (Lo sperimentale et I'imparziale medico), La Tribune 
medicale, 1868, p. 551. 

f Berlin, klin. Woch., 1871, No 25. 
J Op. cit., p. 207. 



AIRS, GASES, VAPORS, AND FUMES. 149 

contains less resin than oil of turpentine, and is not un- 
pleasant to the taste. The breath and urine soon acquire 
its peculiar odor, proving its absorption. It seems 
partly to induce contractility of the sluggish and relaxed 
vessels, and partly to act as an excitant and expectorant 
to the mucous membranes. More than from three to 
five drops are not to be given in a single day, because a 
larger quantity may become too stimulating. Dr. Lewin 
has employed such inhalations with success in chronic 
pulmonary catarrhs, and in pulmonic blennorrhcea ; and 
Dr. Boer recommends its loosening effect from the relief 
experienced by himself in a tight catarrh. It was at a 
much earlier date employed by Copland in bronchitis, 
and recommended by him. 

More recently* Prof. Gerhardt, of Jena, has made 
some further investigations into the action of the Scotch 
oil of pine (sylvestris) in chronic affections of the respi- 
ratory organs. Into a basinful of hot water he drops 
from six drops to two teaspoonfuls of the oil, and the 
patient breathes, through a tube, the vapor that is given 
off, from half an hour to two hours daily. The effect 
of this inhalation was found to be very similar to that 
produced by the oil of turpentine, only that the latter 
was rather more antiseptic, and the former more astringent 
and sorbefacient. The best results were obtained in 
chronic catarrh of the larynx or bronchi, and also in di- 
latation of the minuter bronchi. One case of the latter 
was so far relieved after four weeks' inhalation, that the 
lessening of the calibre of the bronchi was noticeable, 
and the expectoration, which previously had been pro- 
fuse, decreased in quantity, and eventually ceased ; while 

* Lewin, op. cit., p. 208. 
13 



150 THE INHALATION OF 

an inhalation of sal ammoniac instituted earlier had 
been followed by hardly any result. In phthisis the 
benefit was but slight. The inhalations of the oil of pine 
were not always well borne, but in the majority of cases 
soon effected a diminution in the amount of expectora- 
tion. 

The inhalation of this oil of pine (sylvestris) is 
highly recommended by Dr. Morell Mackenzie, of Lon- 
don, as a mild but useful stimulant in chronic laryngitis. 
His formula is two drachms of the oil of pine, with 
sixty grains of light carbonate of magnesium in three 
ounces of water; a teaspoonful of which is to be 
thrown upon a pint of water at 150° F. for each inha- 
lation. I have had considerable satisfactory experience 
with this formula in simple chronic bronchitis, and in 
the torpid chronic bronchitis of phthisis, as well as in 
chronic laryngitis. I have also used the other oils of 
pine with similar good results. 

Dr. Leopold Dittel* speaks well of the inhalation of 
the ethereal oil of pine in catarrh of the pelvis, of the 
kidneys, etc. 

Other Essential Oils. 

Various essential oils have been employed, chiefly as 
a matter of convenience, to take the place of infusions 
of seeds and leaves of the plants in which they are 
contained. They are usually mixed with water with 
the addition of carbonate of magnesium. Of these we 
may make mention of the oils of aniseed, caraway, 
cassia, cinnamon, cloves, cubebs, hops, juniper, marjoram, 

* Schmidt's Jahrb., 1874, May 12th; Brit, and For. Med.-Chir. 
Rev., October, 1874, p. 510. 



AIRS, GASES, VAPORS, AND FUMES. 151 

mint, and sage. Their general effect is mildly stimu- 
lant, and they are applicable to walking and working 
cases of chronic affections of the mucous membrane of 
the respiratory tract generally. The formula given in 
connection with the oil of pine will serve as a type for 
the entire series. 

Oxygenated Essences. 

Dr. Jules Cheron* claims that inhalations of the 
vapors of oxygenated essences, such as camphor, chamo- 
mile, cedar, eucalyptus, etc., will arrest the destruction of 
the lung-tissue in chronic phthisis. 

Creasote. 

Creasote may be inhaled in the proportion of three 
to fifteen drops to the ounce of water, heat being applied ) 
or it may be employed undiluted at ordinary tempera- 
tures. It may be inhaled from any of the inhalers ; or 
very simply, by pouring boiling water over a few drops of 
creasote in the bottom of a teapot, and inhaling through 
the spout. A formula recommended by Mackenzief is 
of the same character as those generally used by him, 
viz.: Beech wood creasote, half a fluid ounce; light car- 
bonate of magnesium, ninety grains; water to three fluid 
ounces; a teaspoonful in a pint of water at 150° F. for 
each inhalation. 

Creasote inhalations will, it is said, often relieve the 
irritative cough of phthisis; allaying the irritation, 
checking the secretion, and facilitating expectoration. 
Thus, even though they may have no specific remedial 
agency, they act beneficially by conserving the patient's 

* Gaz. hebd., December 30tli, 1872. f Op. cit,, p. 84. 



152 THE INHALATION OF 

strength, and preventing exhaustion from paroxysms of 
severe cough and dyspnoea. 

Inhalations of vapors of creasote are reported to 
agree usually very well from the first ; but in irritable 
constitutions, where they are not so readily tolerated, 
it has been recommended to subdue the hypersensitive- 
ness of the mucous membrane, by a previously insti- 
tuted inhalation of the vapor from conium ; and where 
there is any tendency to spasm, to add a few drops 
of the liquor potassae at the moment of employing the 
inhalation. 

Dr. Elliotson* records that in phthisis, he has, in 
many instances, caused patients to breathe for four or 
five minutes at a time, and four or five times a day, a 
mixture of creasote with mucilage and water ; but with- 
out any decided result. He has found such inhalations 
useful, however, in cases of bronchitis with profuse dis- 
charge, those designated as bronchorrhcea ; he has also 
found them useful in asthma; and so likewise in chronic 
affections of the larynx, trachea, and bronchi generally, 
he has found them of great advantage, both when used 
alone, and when conjoined with other medications ; 
furthermore, he has not known any inconvenience to 
have resulted from their employment in a single instance. 

MM. Serres and Andral, in their report read at the 
seance of the Parisian Academy of Sciences, Nov. 30th, 
1857,f upon fumigations of acetic acid and creasote in 
the treatment of chronic bronchitis, recommended by 
Prof. L. Mandl, state that the varieties of bronchitis for 
which this treatment is recommended are: the dry 



- Med.-Chir. Trans., vol. xix, p. 217. 
f Gaz. hebd., December 11th, 1857. 



AIRS, GASES, VAPORS, AND FUMES. 153 

catarrh of Laennec ; chronic bronchitis with unilateral 
snbcrepitant rale ; and the bronchitis of pleurisy. These 
three varieties form a group which is designated by 
Mandl under the name of (bronchite seche) dry bronchitis, 
and characterized by the paucity of symptoms furnished 
by auscultation and percussion. The treatment consisted 
simply in the employment of warm fumigations by 
means of the apparatus described and figured at p. 26. 
Into the vessel are introduced sixty grammes of water, 
and five grammes of a solution composed of five grammes 
of creasote, fifty grammes of acetic acid, and five hun- 
dred grammes of water. The liquid is then heated, 
and the fumes that arise are inspired by the patient. 
The strength of the mixture is to be gradually increased, 
according to the duration of the malady, the suscepti- 
bility of the larynx and bronchi, and so on. Chronic 
mucous catarrh will not yield to the acid fumigations as 
readily as the dry bronchitis. In such cases he employs 
the emetics in addition, repeated whenever indicated by 
the abundance of rales. In the pituitous catarrh, prop- 
erly so called, so frequently connected with an affec- 
tion of the heart, and which in all cases, especially when 
it has existed several years, denotes a considerable degree 
of alteration of the mucous membrane of the bronchi, 
the acidulated fumigations, if well supported, will ame- 
liorate the condition of these tubes, but will not restore 
their normal characters. 

I have sometimes found creasote inhalations of much 
apparent use in the treatment of chronic coryza or so- 
called post-nasal catarrh, inspired through the nostrils 
after thorough cleansing by douche and syringe. 

Xaphtha (wood naphtha), introduced into practice by 



154 THE INHALATION OF 

Crichton in 1816, at one time* attracted some favorable 
attention as a remedial agent in phthisis, diminishing 
dyspnoea, relieving cough, and facilitating expectoration ; 
its action being quite analogous to that of creasote. 

Benzine, the product of the distillation of coal naph- 
tha, has been employed by Lochnerf in the treatment of 
whooping-cough; small quantities being placed in a 
number of shallow vessels and arranged at convenient 
points about the bed of the patient. 

Prof. Chapman J found benefit from the fumes of con- 
centrated pyroligneous acid in foul ulcerations of the 
throat and nostrils. 

Of late years the use of creasote and allied products 
has been almost entirely superseded by the substitution 
of carbolic acid. 

Carbolic Acid. 

Vapors of carbolic acid are employed in the same 
affections for which creasote has been recommended, and 
have, in great measure, superseded the use of the latter 
remedy. From one to ten drops or more of the concen- 
trated acid, or an equal number of grains of the crys- 
tallized acid, with an equal quantity of alcohol, in a 
drachm of water, may be thrown upon a pint or more of 
warm water. A bit of cotton, upon which a few drops 
of the concentrated acid has been poured, may be placed 
in a wide-mouthed vessel, and the vapor be inhaled 
at ordinary temperatures. Dr. Somerville Oliver sug- 
gests wearing a small net or respirator, in which a 

* Hastings, Pulmonary Consumption treated with Naphtha, 
London, 1845. 

f Gaz. medicale, October 20th, 1866. 
J Therapeutics, vol. ii, p. 36. 



AND FUMES. 155 

woollen cloth, impregnated with the solution, is to be 
introduced.* It may be exposed by the bedside in sau- 
cers, or other shallow dishes, to impregnate the atmos- 
phere. I have frequently used it in combination with 
tincture of iodine in chronic laryngitis and bronchitis, 
and with very satisfactory effects. It is also useful in 
all cases of fetid odor from the mouth and air-passages. 

Dr. Mackenzie recommends it in syphilitic and car- 
cinomatous affections of the larynx, etc. 

In combination with ammonia, it has been recom- 
mended by Dr. Hagner to avert a cold or catarrh. A 
mixture containing five parts of carbolic acid, fifteen 
of rectified spirits of wine, five of strong water of am- 
monia, and ten of water, is kept for use in a glass-stop- 
pered dark bottle. When a catarrh is commencing, the 
patient is to pour a few drops on three or four layers of 
blotting-paper, which he is to take in his hand, when, 
closing his eyes, he is to take deep inspirations as long 
as any vapor is given off; and this process is to be re- 
peated at intervals of two hours. f 

Dr. Burchardt, of Berlin, has reported favorable re- 
sults in whooping-cough from the vapors of a solution 
containing from one and a half to two per cent, of carbolic 
acid, boiled in the boiler of a Siegle or similar appa- 
ratus, inhaled three times a day into the widely opened 
mouth, at a distance of about twenty centimetres from 
the extremity of the tube. The violent paroxysms of 
cough disappeared in two or three days, and the whoop- 
ing-cough was succeeded by a simple catarrh in the 
space of about eight days. This kind of medication 

* The Lancet, July 8th, 1871, p. 45. 

f E. Brand, Berlin. Klin. Woch., 1872, No. 12. 



156 THE INHALATION OF 

often succeeds in a remarkable manner in catarrhal af- 
fections of the vocal cords, and proves equally useful in 
chronic catarrh of the trachea, especially when the ex- 
pectoration takes on a putrid character, and presents the 
yellow tint peculiar to the production of fungi.* 

Carbolic-acid vapor has been also recommended in 
whooping-cough by Dr. Robert J. Lee.f 

Opium and other Narcotics. 

Opium. — Opium, as is well known, has long been in- 
haled in the East for sensuous purposes. The Chinese 
place a portion of the extract, the size of a pea, into the 
bowl of a pipe, which is heated over a flame for a time, 
and then the opium is set on fire and the smoke forcibly 
inhaled. Its effects are sedative and narcotic. 

EthmullerJ first employed opium fumes in Germany 
for therapeutic purposes. He let from ten to twenty 
grains of opium burn on glowing iron by the patient's 
bedside, and found the practice useful in hysteria, mel- 
ancholia, excitable nervous fevers, and severe spasms. 

The fumes of opium have been recommended in 
coryza.§ 

Dr. Snow's method is to place the required quantity 
of the extract, in the form of a pill, upon the capsule of 
his inhaler (described on pages 27 and 28), and then 
the spirit-lamp is lighted beneath ; the patient begin- 
ning to inhale immediately, and continuing to do so 
until volatilization ceases, the process usually lasting 

* London Medical Record, Feb. 3d, 1875, p. 73. 
f Brit. Med. Jour., 1875, p. 229. 

X (Med.-Chir. Zeitg., 1809, 3, p. 255); Waldenburg, op. cit., 
p. 595. 

I Am. Jour. Med. Sci., July, 1855, p. 207. 



AIRS, GASES, VAPORS, AND FUMES. 157 

about ten minutes, and leaving as residue a porous car- 
bonized mass. 

Morphia, in doses of half a grain, may be used for 
inhalation in preference to opium, than which it is said 
to be pleasanter, inasmuch as the extract of opium sup- 
plies some smoke in addition to its active principles. 
The morphia is mixed with dry plaster of Paris to in- 
crease its bulk. f 

Inhalation of the fumes of opium is recommended by 
Armand,* not only in affections of the respiratory organs, 
but also in nervous affections of the heart, in the various 
neuralgias, and in muscular and articular rheumatism. 
He has found it a very suitable remedy in bronchitis, 
chronic laryngitis, whooping-cough, and asthma. He 
allows the patient to smoke from five to fifty centi- 
grammes of the extract within the twenty-four hours, 
an amount which he states can be smoked without any 
unpleasantness and with a very favorable action. 

The vapor from the camphorated tincture of opium, 
an ounce or more thrown upon a pint of steaming water, 
will often be found to act well as a sedative in cases 
of moderate irritability of the larynx, with continuous 
disposition to cough ; the combined effects of the cam- 
phor, benzoin, and aromatics with the opiate rendering 
it usually particularly grateful to the parts. It can also 
be added with advantage to other substances to modify 
their pungency. 

The extract of lactucarium has occasionally been em- 
ployed as a substitute for opium. 

Cannabis Indica. — This remedy is used by the Per- 

* Gaz. med., Paris, 1868, 50; Le France med., 1868, 99, p. 739. 

14 



158 THE INHALATION OF 

sians, by inhalation, in diseases of the respiratory or- 
gans.* 

It has been recommended in phthisis by Desmartis.f 

Stramonium. — Inhalation of the fumes of the datura 
leaves has long been a popular remedy for asthma in the 
East Indies. 

The use of the datura stramonium in asthma was 
brought into notice by Dr. Sims, m 1802, J the common 
thorn-apple being substituted by one of his patients for 
the wild thorn-apple (datura ferox), imported from the 
East Indies, the supply of which had given out in this 
instance. The latter plant seems to have been used for 
the purpose in the East Indies for a very long time. 

Inhalation of vapors of stramonium has been highly 
extolled by Martin Solon, Andral, Trousseau, Thery, 
and many other Continental authorities, and by Salter, 
of Great Britain. It has been employed a good deal in 
the United States, though not much positive information 
has been recorded. These vapors are also said to give 
relief in the exhausting cough and impeded respiration 
of phthisis, in spasmodic and hysterical cough, and in 
dyspnoea from any cause. 

The dried leaves, the fibres of the root, or the seeds, 
may be smoked alone, or with tobacco if the patient is 
accustomed to tobacco, either in a pipe or a cigarette ; 
or cigars may be steeped in a strong decoction of stra- 
monium and then dried until fit for smoking. 

As ordinarily smoked, it is doubtful whether the 
remedy gains access into the lungs; but if the smoke, as 

* Polak, Bericht der dentschen Naturforscher. Versammlung 
zu Kohigsberg, 18G0; Waldenburg, op. cit., p. 604. 
f (Union med., 1861, Nov. 7). Waldenburg, op. cit., p. 601. 
J Review in Edinb. Med. Jour., July, 1812, p. 365. 



AIRS, GASES, VAPORS, AND FUMES. 159 

it issues from the mouth after the puff of the smoker, is 
drawn back by an act of inspiration, it will then be 
inhaled into the lungs, and the effect will be more cer- 
tain and more prompt ; otherwise it does not enter the 
larynx, and the effect is in great measure due to ab- 
sorption by the mucous membrane of the mouth and 
pharynx. 

Extract of stramonium has been used by inhalation 
in the same manner as extract of opium, in cases of 
asthma, and with asserted relief. 

Dr. Nevins* directs an ounce of the dried leaves, 
moistened in a solution of half a drachm of the watery 
extract of opium, dried, and rolled in paper into ciga- 
rettes, in attacks of nervous (spasmodic) asthma, in 
hysterical coughs, and in dry, obstinate- coughs symp- 
tomatic of more or less severe chronic affection of the 
lungs. 

M. Dannecy, of Bordeaux, finding that asthmatic pa- 
tients had experienced considerable relief from smoking 
the leaves of borage and pellitory, — plants containing 
much nitrate of lime, endeavored to avoid the too copi- 
ous production of smoke in the narcotic plants most 
usually employed, which often fatigues patients and 
sometimes excites cough, by saturating the leaves of 
belladonna and stramonium with nitre. The plants, 
dried and conveniently spread out, are watered with a 
solution of nitrate of potassium, in the proportion of three 
ounces of the salt to rather more than two pounds avoir- 
dupois of these plants. As the solution penetrates the 
entire vegetable tissue, the plants, when dry, will burn 

* Art of Prescribing, p. 298. 



160 THE INHALATION OF 

completely without the formation of the objectionable 
pyrogenous products.* 

Dr. Salterf thinks the inhalation of the fumes of 
stramonium does more in the way of prevention than 
cure ; that he has seen better results from the long-con- 
tinued practice of smoking a pipe of it the last thing at 
night, whether an attack of asthma is threatening or 
not, than by waiting until a paroxysm comes on. 

Three or four pipefuls of stramonium are usually 
smoked at each administration; or the smoking is con- 
tinued, with interruptions, from a few minutes to half an 
hour. 

In irritable bronchitis, stramonium is sometimes 
smoked in the same way, as a sedative, with equal parts 
of sage ;X or it may be made into cigarettes, twenty of 
which are formed of an ounce of stramonium and half 
an ounce of sage. 

Stramonium cigars are usually made from datura 
tatula, which is stronger than the datura stramonium. 

Belladonna. — Belladonna, employed in a similar 
manner, has been recommended by many of the same au- 
thorities for the cure of spasmodic asthma. It is some- 
times mixed with tobacco and smoked; and sometimes 
the vapor from an infusion in water is inhaled. The 
latter plan has been recommended in whooping-cough. 

The fumes of belladonna have been recommended by 
M. Schroeder as an effectual agent in arresting haemop- 
tysis, in effecting which, it at the same time allays cough 



* (Bull, de therapeutique, 1857, t. Ill, p. 455; Dublin Hosp. 
Gaz., March 1, 1858) ; Am. Jour. Med. ScL, July, 1858, p. 204. 
f On Asthma, Phila , 1864, p. 112. 
J Trousseau, Art of Prescribing, London, 1858, p. 298 



AIRS, GASES, VAPORS, AND FUMES. 161 

and produces a feeling of relief in the chest. The plan 
pursued by him was to cut the dried leaves into small 
pieces, and throw about two drachms upon burning coals, 
so that the patient may be enabled to inspire the fumes as 
they arise. It is said that inhalation of the steam from 
a decoction of these leaves, or their internal adminis- 
tration, does not appear to have an equally beneficial 
effect.* 

Belladonna and stramonium are often used in combi- 
nation, to overcome the paroxysms of asthma; and most 
of the cigarettes vended for use in that malady contain 
the two ingredients. 

Trousseau's formula for narcotic cigarettes is as fol- 
lows : Fol. belladonnas, 30 centigrammes ; fol. hyoscy- 
amus, 15 centigrammes; fol. stramonii, 15 centigrammes; 
ext. opii. gummos, 13 milligrammes: aquas laurocerasi, 
9 J grammes. 

The famous cigarettes of Espic are made according to 
the same formula, with the addition of 5 centigrammes 
of phellandrium aquaticum. 

Conium. — Conium was used by Scudamore to lessen 
the irritation of the iodine vapors (see p. 98) so much 
extolled by him. Snowf employed a cold inhalation of 
one part of conium to nine of alcohol, to relieve cough 
and facilitate respiration. StokesJ found conium useful 
in bronchitis and in phthisis, twelve or fifteen grains of 
the extract being diffused in a proper inhaling apparatus, 
and the vapor drawn into the lungs for a quarter of an 
hour, once or twice a day. 

* (Annali universi di medecin, April, 1845) ; Ranking's Ab- 
stract, 1845, 11, p. 75. 

f London Med. Jour., February, 1851. 

X Diseases of the Chest, Philadelphia, 1837, p. 83. 



162 THE INHALATION OF 

Hyoscyamus. — Dr. Pearson, of London, was in the 
habit of using in phthisis, the inhalation of the narcotic 
vapors evolved by the maceration of from a scruple to a 
drachm of the leaves of hyoscyamus in an ounce of ether. 

Tobacco. — In individuals who by habit have not lost 
their susceptibility to the effect of this plant, the inhala- 
tion of the smoke from tobacco will sometimes serve a 
good purpose in nervous affections of the respiratory 
organs. It has thus been recommended in ordinary 
spasmodic cough, in whooping-cough, in asthma, in 
phthisis, and in spasmodic croup. 

Prof. Chapman, of Philadelphia, prescribed the 
smoking of tobacco with success in the spasmodic croup 
of a female adult.* He employed it for the purpose of 
exciting nausea and producing relaxation of the spasm 
of the larynx ; and he also reported advantage from its 
use in the dyspncetic condition of asthma. 

In hay-asthma, according to Salter,f tobacco pushed 
ad nauseam gives more relief than any other remedy, 
and is sometimes the only effectual one. He preferred 
what is known as the bird's-eye brand. 

To produce its due effect, care should be taken that 
the tobacco smoke be inhaled into the lungs. 

Some narcotic substances are volatilized by the direct 
action of heat, the inhalations being dry ; and others 
in association Avith vapor of water in infusion, the inha- 
lation being moist. Only such substances as contain 
volatile ingredients are suitable for administration by 
the latter method, but few alkaloids being volatile at tem- 

* Am. Jour. Med. Sci., vol. i, 1827-28, p. 477. 
f Lancet, 1858, September 11th, p. 302; On Asthma, Phila. 
ed., 1864, p. 122. 



AIRS, GASES, VAPORS, AND FUMES. 163 

peratures employed for therapeutic purposes. Nicotine 
and coniin are volatile ; consequently tobacco and co- 
nium can be used ; belladonna and hyoscyamus can be 
used ; but digitalis and opium are not suitable for this 
method of administration. 

Hydrocyanic Acid. — Hydrocyanic acid in weak 
solution is sometimes employed by inhalation, a few 
drops (five to ten) of the dilute acid being thrown upon 
a quantity of hot water. 

Maddock* and some others have reported favorable 
results in whooping-cough and asthma. Snow and others, 
on the other hand, have not witnessed any special bene- 
ficial results from hydrocyanic acid or its preparations. 
It is sometimes useful in allaying the distressing cough 
of the chronic laryngitis of phthisis. It is sometimes 
used in the form of cherry-laurel water, alone, or as the 
menstruum for astringent and other inhalations in which 
the addition of a sedative is desirable. 

Nitrate of Potassium. 

Inhalation of the fumes arising from the ignition of 
saltpetre, a remedy first employed in this country, has 
been found of much service in the paroxysms of asthma. 
Pieces of bibulous paper, such as ordinary red blotting- 
paper, are soaked in a saturated solution of the nitrate 
and then dried. When to be used, the paper is set on 
fire in a convenient vessel and the patient inhales the 
fumes as they are given off, or merely breathes the air 
of the apartment. Sometimes the impregnated paper 
is smoked in a pipe in the same way as ordinary to- 
bacco. These fumes have likewise been used with some 

* Op. cit., p. 73. 



16tt THE INHALATION OF 

success in whooping-cough, and in spasmodic coughs gen- 
erally. They are recommended by Mackenzie* in spas- 
modic dyspnoea due to spasm of the adductor muscles of 
the vocal cords. More asthmatic patients, I believe, are 
benefited by this smoke than by any other single remedy. 
Leaves of belladonna and stramonium are sometimes 
steeped in a saturated solution of this salt, so as to secure 
the combined effects of the narcotic also. A good deal 
depends upon the manner in which nitre-paper is pre- 
pared. Dr. Salterf calls attention to the fact that the 
paper, if too thin, will not take up sufficient nitre, and if 
too thick will make the fumes too carbonaceous ; and 
that the strength of the solution should be saturated at 
the ordinary temperature lest the paper become too 
much impregnated with nitre, and thus burn too fast 
with a sudden explosive flame. The paper should have 
little or no wool in its composition. He states that 
there should be no brown smoke in its combustion, but 
light, clear, white fumes. He gives the following 
method of preparation, recommended by a patient, 
which he found very efficacious: " Dissolve four ounces 
of saltpetre in half a pint of boiling water; pour the 
liquor into a small waiter just wide enough to take the 
paper; then draw it through the liquor and dry it by 
the fire.' 7 The paper may be cut in pieces about four 
inches square, one or two of which may be burned at 
once. 

Camphor. 

This substance was probably first employed by inha- 
lation by the Arabian physician, Avicenna. Iii the form 

* Op. cit., p. 73. 

f On Asthma, Philadelphia ed., 1864, p. 151. 



AIRS, GASES, VAPORS, AND FUMES. 165 

of vapor, camphor is sometimes inhaled in coryza, asth- 
ma, croup, spasmodic coughs, and chronic catarrhal 
affections; and there is no doubt that its constitutional 
impression may be obtained in the same way. It may 
be inhaled by means of an ordinary inhaler, placed in 
water more or less heated, to favor the volatilization of 
the camphor. 

A drachm or more of the tincture of camphor may 
be placed in an ounce of water, and inhaled with the 
watery vapor evolved by a spirit-lamp, care being taken 
to protect the eyes from its irritating influence. 

In the inhalation of camphor, care must be taken to 
arrest the process when signs are exhibited of its acting 
on the brain. 

M. Raspail recommends that a small tube, a quill, for 
example, should be filled with the coarsely powdered 
drug, and loosely closed at each end with a cotton wad, 
so as still to admit the passage of air; and that this 
should be used in the same manner as a cigar, but with- 
out burning. 

Dr. Snow, of London, has reported relief to the 
cough of phthisis by the inhalation of vapors of cam- 
phor.* 

A piece of camphor held before the nostrils, so that its 
vapor may be snuffed up into the nasal passages, is some- 
times beneficial in coryza, and in serous catarrh of the 
nasal passages. Powdered camphor has been recom- 
mended to be used in the same way, and for the same 
purpose, as well as for the relief of various spasmodic or 
catarrhal affections of the air-passages. f 

* London Med. Jour., February, 1851. 

f Wood's Therapeutics and Pharmacology, Philadelphia, 1860, 
vol. i, p. 714. 



166 THE INHALATION OF 

Inhalations of the vapor of camphor were much em- 
ployed by Dr. Bodtcher, of Copenhagen, especially in 
spasmodic affections. 

The inhalation of vapors of camphor with those of 
iodine have been used successfully by Prof. A. P. Mer- 
ril, of Memphis, Term., more recently of New York.* 

Vogel has had successful results in spasm of the glot- 
tis, from the constant use of a camphorated atmosphere, 
secured by placing a bit of camphor in a bag of gauze 
or linen, to be worn about the patient's neck.f 

WaldenburgJ has tried this method in similar cases 
with considerable benefit, and also in a case of spasmodic 
cough. 

The ordinary spirits of camphor, cautiously inhaled 
from the bottle, will usually give all the advantages of 
the drug itself. Such inhalations I have sometimes 
found efficient in facilitating excretion, and in toninp; 
the mucous membrane in chronic nasal catarrhs. The 
inhalation of camphor is occasionally employed as an 
antiseptic during direct exposure to typhus and typhoid 
fever and the like. 

Lime. 

The direct inhalation of lime in sthenic and in diph- 
theritic croup — or rather vapor of water containing small 
particles of lime in suspension — was suggested by Dr. 
A. Geiger, of Dayton, Ohio. The vapor is produced by 
pouring hot water upon small pieces of unslacked lime. 
The ebullition is such in the process that a profusion of 
minute particles of the lime becomes detached and forced 

* Memphis Medical Recorder, March, 1855, p. 228. 

f Lerbuch der Kinderkrankheilen, Erlangen, 1860, p. 253. 

% Op. cit., p. 654. 



AIRS, GASES, VAPORS, AND FUMES. 167 

up with the steam arising from the vessel in which the 
slacking is going on, and remain with it in suspension, 
so that the compound can be readily inspired. 

Dr. Geiger, after narrating a very interesting case of 
diphtheritic croup in which large portions of membrane 
retaining the cast of the entire trachea were coughed up, 
and a portion of which he found to become dissolved in 
lime-water,* continues: 

u I determined to try the effects of the lime in the next case of 
diphtheria, or pseudo-membranous croup, occurring in my prac- 
tice. The first case that presented itself was one of croup, in a 
boy about four years of age (son of Irish parents), residing some 
two miles from the cit} T . The boy had already been sick two days 
before my visit. When called, I ordered the father to take out with 
him some unslacked lime, which he did. Upon my arrival at the 
house, I found the patient sitting up in bed ; severe and distress- 
ing dyspnoea ; the face and body covered with perspiration from 
his efforts to get his breath. The usual harsh, dry cough, and the 
symptoms all indicating the last stages of pseudo-membranous 
croup, I determined to try alone the effects of the lime, as I saw 
no hope in any other treatment. But in what way could I bring 
it in contact with the membranous formation to dissolve it ? I hit 
upon the following expedient : I placed some unslacked lime in a 
saucer, and then, after throwing a cloth over his head, held the 
saucer under, so that he was compelled to breathe the fumes aris- 
ing from the lime in the process of slacking. I retained it for a 
few minutes and then removed it. The breathing was some easier, 
and directly he expectorated a large quantity of tough mucus and 
phlegm, and was very much relieved. In this process, the steam 
arising from the lime in slacking, contains in it particles of lime 
which are thus, by inhalation, brought in contact with the mem- 
brane in the windpipe. I ordered lime-water and milk to be 
given internally, and the inhalations to be repeated in the same 
way, whenever the symptoms of suffocation were severe, and 
that the father should report to me in the morning the boy's 
condition. 

" He came in the following morning, said ' he was much better; 



Med. and Surg. Reporter, Philadelphia, March 24th, 1866. 



168 THE INHALATION OF 

that the night before, after again inhaling the fumes of the lime, 
he had vomited up a lot of tough stuff, and got better right away.' 
I prescribed a cathartic to be given him, and the fumes of the 
lime, if he choked up again. I saw the patient no more. The 
father reported from day to day that he was getting better, and 
finally, that he could ' eat as much as ever.' " 

Dr. Geiger, in the same communication, reports another case of 
a fleshy little boy, three or four years of age, attacked two days 
previous to his visit. There was hard breathing, stridulous cough, 
with evidence of the formation of membrane, though to less ex- 
tent than in the case above. A purge was ordered, and directions 
given how to employ the lime inhalations. Visiting the child 
again in a few hours, he found the difficulty in breathing quite 
relieved ; the mother reporting that the lime had acted like a 
" miracle ;" that after breathing the fumes for a few minutes, he 
vomited freely and was at once relieved. On the day following, 
the child was so well that further medication was unnecessary. 

Dr. Geiger also states that Dr. O Crook, of the same city, re- 
ported six cases of diphtheria and membranous croup, in which 
the fumes of lime and lime-water were used, five of which cases 
recovered. 

Dr. Geiger reports another successful case in the same journal 
for March 10th, 1866. 

Dr. Alexander J. C. Skene, of Brooklyn, N. Y., reports* that 
he has tried the inhalation of lime-water broken up into spray by 
Richardson's Spray Producer, in several cases of croup, and be- 
lieves that he has observed marked advantage derived thereby. 

Dr. Thomas Byrnes, of Walcott, Iowa,f reports a case of diph- 
theria in a child seven years of age, in which, when he was called 
to the case, the tonsils were large, and the mucous membrane of a 
bright-red color, a small patch of membrane covering the left 
tonsil. The constitutional symptoms were very slight. He 
swabbed the throat with tr. ferri chloridi, and administered five 
drops internally every hour. The following morning the tonsils 
were covered with false membrane, which had ascended to the 
palatine arches. Small patches were visible on the uvula also. 
The cervical and submaxillary glands had become very much 
swollen, and painful to the touch. The lime was prepared for in- 

* Med. and Surg. Rep., Dec. 22d, 1866, p. 527. 

f Med. and Surg. Rep., Philada., July, 1866, p. 26. 



AIRS, GASES, VAPORS, AND FUMES. 169 

halation, as directed by Dr. Geiger, and it soon exerted its bene- 
ficial effect. Small patches that covered the uvula were entirely 
dissolved, and those on the tonsils were diminished in size. The 
inhalations were continued at intervals of four hours. Towards 
evening, the false membrane had entirely disappeared, but re- 
turned again the next day, and was again removed by lime inha- 
lations. The systemic affection in this case was combated by sup- 
porting measures, and the internal administration of iron. 

Dr. C. V. Moore,* of Stillwater, New Jersey, writes as follows : 
" I have recently had two severe cases of diphtheria. In one the 
disease had invaded the larynx, causing loss of voice, croupy 
cough, and paroxysmal attacks of suffocation and dyspnoea. Both 
cases were promptly relieved, and cured simply by the inter- 
nal administration of small and oft-repeated doses of permanga- 
nate of potassa, and the inhalation of vapor of slacking lime. The 
relief from the inhalation was very marked, and the result was 
gratifying, both to the little sufferer, the friends, and most assur- 
edly to the attending physician." 

These cases were sporadic. Internal treatment, milk and beef 
tea. 

Acting Assistant Surgeon Henry McElderr} 7 , United States 
Army,j- reports a case of diphtheria, in which, in addition to sup- 
porting systemic treatment, the inhalation of lime with steam, 
from the action of hot water on unslacked lime, was employed 
with the successful removal of rapidly spreading diphtheritic de- 
posit on the left tonsil and on the arches of the palate on that side. 
He writes that the instantaneous relief given by the inhalations, 
when he has seen so many remedies signall} 7 fail in diphtheria, 
has led him to attribute the very fortunate and successful issue in 
this case entirely to their influence. He has never seen any remedy 
act with more promptness or satisfaction than the lime inhalations 
did in this case. 

Many more successful cases have been reported sub- 
sequently, confirming the statements and results of Dr. 
Geiger, with which my own experience is in full accord. 

My own experience with inhalations of the hot vapor 

* Med. and Surg. Reporter, Philada., Sept. 5th, 1866, p. 224. 
f Med. and Surg. Reporter, Philada., April 28th, 1866. 



170 THE INHALATION OF 

from slacking lime has been decidedly satisfactory, and 
I would not like to be prohibited from employing it in 
the management of a serious case of membranous croup. 
In some dozens of cases, in private and in consultation 
practice, I have seen life apparently rescued through its 
agency. Of all the methods of treating croup advanced 
of late years, I know of no other that has held its 
ground so well as this. The general plan pursued by 
myself is to keep up a continuous evolution of steam 
from boiling water, and to administer the lime in the 
manner indicated by Dr. Geiger, for ten minutes at a 
time or thereabouts, whenever the respiration evinces 
the presence or formation of membrane; repeating it at 
intervals of half an hour, an hour, two hours, or longer, 
according to circumstances ; and recurring to the remedy 
whenever the respiration is impeded by the exudation. 
I find a large piece of stiff wrapping-paper, the size of 
an ordinary newspaper, loosely folded into a funnel- 
shaped cone, one of the best means of directing the vapor 
towards the mouth of the patient. A large, stiff paper 
bag, with one of the corners cut off obliquely, and in- 
verted over the vessel, answers the purpose admirably. 

Arsenic. 

Vapors produced by burning sulphide of arsenic were 
anciently used in the East for medicinal purposes. 
Avicenna employed the fumes of arsenic in the treatment 
of asthma.* The poisonous effects of arsenical vapors 
in those unaccustomed to them are well known. Their 
therapeutical employment in chronic laryngitis and 
bronchitis, in asthma, in the treatment of chronic bron- 

* Floyer, On Asthma, London, 1718, p. 169. 



AIRS, GASES, VAPORS, AND FUMES. 171 

chial affections, and in phthisis, was revived by Trous- 
seau,* in the form of the cigars of Dioscorides. This 
method consists in inhaling fumes arising from burning 
cigarettes, made from bibulous paper, saturated in a 
watery solution of arseniate of sodium or of potassium, 
from half a drachm to a drachm to the ounce of water. 
Each cigarette absorbs about half a drachm of the solu- 
tion. The cigarette is to be smoked like an ordinary 
cigarette of tobacco; the patient inhaling the smoke into 
the bronchi from two to ten times during the process, 
and repeating it two or three times a day. 

A correspondent in the Medical and Surgical Reporter 
has reported two cases of success in the treatment of 
spasmodic asthma, f the patients having smoked a small 
pipe, half full of tobacco, to which one-fourth of a grain 
of arsenious acid had been added. The cases were of 
more than twenty years' standing ; and the attacks ceased 
after six days' use of the remedy, once daily. 

In a case of painful neurosis of the larynx, Wisting- 
hausenj employed the vapor evolved by heating a 
couple of drachms of water, to which three drops of 
Fowler's solution had been added. 

Dr. Anstie read a paper on cardiac neuralgia, before 
the British Medical Association, § in which he stated 
that one of the two remedies which yielded him the best 
permanent results was arsenic given by the stomach or 
by inhalation. 

* Gaz. des hop., 1841, No. 10. The Preserver's Complete 
Handbook, London, 1858, p. 255. 

f Philada., November 16th, 1861, p. 164. 

% (Petersburger med. Zeitschr., 1862, p. 129), Waldenburg, op. 
cit., p. 674. 

I Practitioner, October, 1868, p. 257. 



172 THE INHALATION OF 



Mercury. 



The inhalation of mercurial vapors has been employed 
for ages in India and in Arabia for the purpose of excit- 
ing salivation in the treatment of certain diseases. The 
patient is covered with a blanket, beneath which is 
burned a candle, composed of cotton cloth smeared with 
melted beeswax, and impregnated with an equal quan- 
tity of cinnabar in powder; the vapor therefrom being 
inhaled into the respiratory tract. 

The inhalations of vapor from cinnabar were employed 
at a very early date, in the treatment of constitutional 
syphilis; and the names of de Vigo, Guido, Fracastori, 
and others,* are associated with their use. 

Dr. Samuel Jackson, of Northumberland, employed 
the vapors from calomel, and devised a very convenient 
apparatus for their ad ministration, f which consists of a 
tin vessel the shape of an inverted funnel, to the pipe of 
which flexible tubing is attached. A little door permits 
the introduction of a heated iron (about two pounds in 
weight), which rests on a sheet-iron stand. The iron is 
heated not quite to redness, and placed upon the stand. 
Ten grains of the powder (separated by filtration from 
a mixture made by shaking four ounces of calomel in 
six ounces of water, to which two drachms of ammonia 
water, or the simple or aromatic spirit of ammonia, has 
been added) is thrown on the iron, and the door is then 
closed. The vapor is evolved in the reservoir and in- 
haled through the flexible tube. AVhen evaporation 
ceases, another portion of powder is thrown on the iron, 
and in this way from two to six portions are used in 

* Fracastori, in Copland on Bronchitis, 1866, p. 133. 
f Am. Jour. Med. Sci., vol. i, p. 321. 



AIRS, GASES, VAPORS, AND FUMES. 173 

succession ; the entire process being repeated every two, 
four, six, or eight hours, according to the exigencies of 
the case. Salivation usually ensues at a period varying 
from twelve to seventy-two hours. 

Dr. Nevins relates his experience with mercurial 
vapors in the treatment of aphonia, fetid coryza impli- 
cating the frontal sinuses, nasal polypus, obstruction of 
the Eustachian tube, and asthma.* He employed the 
cigarettes recommended by Trousseau,f and made as fol- 
lows : " Take of nitrate of mercury and strong nitric 
acid, of each fifteen grains, and distilled water six 
drachms, or a sufficient quantity. Mix the acid and 
water, and dissolve the nitrate of mercury by the aid of 
a gentle heat, which may be obtained on the top of an 
ordinary oven. Then soak in the solution a piece of 
thick, white blotting-paper, six inches by eight, and dry 
it. Before it is quite dry, cut it into eight slips, and 
roll each of these round a thin pencil, so as to make a 
small paper tube. To prevent this from unrolling, the 
free edge should be gummed. The cigarette is now 
complete, and when dry, will burn like touch-paper 
when smoked. The interior may be stuffed with to- 
bacco if desired, or the paper itself may be rolled into a 
cigar, along with tobacco in the first instance ; but it 
ought always to be rolled before being quite dry, as it is 
liable to become brittle when perfectly dry, and to crack 
in the operation of folding. It sometimes happens that 
the nitrate of mercury does not become perfectly dis- 
solved, even by the aid of the gentle heat, in which case 



* (Liverpool Med.-Chir. Journal, Jan. 1859) ; Am. Jour. Med. 
Sci., April, 1859, p. 541. 

f The Preserver's Complete Handbook, London, 1858, p. 247. 

15 



174 THE INHALATION OF 

the mixture should be stirred up previous to the paper 
being immersed in it, and a slight degree of agitation of 
the liquid will diffuse the undissolved nitrate uniformly 
over the paper." 

M. Thierry advises that these cigarettes should be 
prepared with a solution of corrosive sublimate. 

It is intended that eight or ten mouthfuls of the smoke 
should be inhaled into the bronchi several times a day. 

Trousseau recommended the use of these cigarettes in 
simple chronic laryngitis, as well as in pharyngitis and 
laryngitis of syphilitic origin. 

Dr. Polak* speaks of the mercurial inhalations em- 
ployed in the Orient for the treatment of syphilis. He 
says that in Persia the readiest method of curing syphil- 
itic affections is by means of inhalation. There is added 
to the moistened narghile-tombac a trochiscus of cinna- 
bar ; and a pipe thus prepared is smoked by the patient 
once or twice a day. 

The ordinary formula for the pastille is as follows : 
Cinnabar, two muskals (1 muskal is equal to 66 grains 
apothecaries' weight); catechu, two muskals; borax, one- 
half muskal ; Lawsonia, two muskals ; china nodosa, 
three muskals ; combined with mucilage of gum arabic, 
and formed into twelve troches. Another formula is 
cinnabar two M., mercury two M., teaves of cannabis 
indica three M., made with mucilage into fourteen 
troches. 

One or two of these pastilles is to be smoked daily, 
and in the following manner : The smoke is inhaled 
into the lungs, retained there for a few moments, and 
then expired through the mouth alone or through the 

* Wiener medic. Wochenschrift, 1860, No. 36. 



AIRS, GASES, VAPORS, AND FUMES. 175 

mouth and nose together. Generally, a moderate mer- 
curial stomatitis ensues after the eighth or tenth inha- 
lation ; and this is a sign for discontinuing the process. 
During the treatment the patient must rinse out the 
mouth frequently, and be careful to observe great clean- 
liness. The diet consists of milk with sugar, rice and 
milk with sugar, and also sheeps-feet jelly. Salt food, 
acids, and fruits are interdicted. The mercurial stomatitis 
is treated with powdered sumac, with catechu, or the ta- 
baschis (bambus magnesia), with gulnar (full flowers of 
the pomegranate). According to these investigations of 
Dr. Polak, no other method is comparable with that of 
these inhalations for the prompt treatment of syphilitic 
affections of the throat. Dr. Polak found that the in- 
halation of cinnabar was very well borne, even by young 
children ; that six to eight strong pulls produced a 
slight sensation of approaching syncope, continuing, 
however, only for a short time, and allowing the opera- 
tion to be repeated by the next day. 

The treatment of croup and diphtheria by inhalations 
of the moist vapor of sulphuret of mercury (cinnabar) 
has been recommended by Abeille,* Bregeant,f and 
others. 

The vapors from preparations of mercury should be 
inhaled diffused in the vapor from hot water. The ap- 
paratus of Langlebert and Bumstead (pp. 28, 29) are 
especially adapted to generating mercurial vapors in 
combination with the vapor of water; the method usually 
adopted in consequence of the irritating qualities of the 

* Gaz. med., Paris, 1867, pp. 527, 569, 582, 598 ; Gaz. des. hop. 
1868, 127; Wien. med. Woch., 1869, 1, p. 10. 
f Gaz. med., Paris, 1868, p. 80. 



176 THE INHALATION OF 

dry mercurial vapor, the bisulphuret (cinnabar) giving 
off sulphurous acid, and the protochloride (calomel) giv- 
ing off hydrochloric acid fumes. Dr. Henry Lee* states 
that the irritating qualities of the vapor of calomel may 
be still further diminished by its being resublimed two or 
three times before it is used; by which action, as he con- 
ceives, any free hydrochloric acid is driven off. The 
apparatus employed by Mr. Lee is similar in appearance 
to that of Bumstead, only the case surrounding the spirit- 
lamp is made principally of wire-gauze, on the principle 
of the Davy safety lamp. The top of the case is fitted 
with a central, movable, small circular plate, surrounded 
by a trough, which should contain one ounce of water 
only. The water should be boiling when poured into 
the trough, or should be allowed to remain over the 
lighted lamp until it begins to boil, when the proper 
quantity (thirty grains, if it is intended to fumigate the 
entire body) of perfectly dry resublimed calomel is then 
spread out on the central small circular plate. This 
apparatus is intended chiefly for fumigations of the en- 
tire cutaneous surface from the neck downwards, the 
cloak in which the patient is enveloped being opened in 
front now and then during the fumigation, so that the 
vapor may be inhaled for a minute at a time, at intervals 
of five minutes, thrice at each sitting. It is recom- 
mended that the moistened calomel vapor pass for about 
six inches through the common air before it is inhaled. 

Chloride of Copper. 

Dr. Th. Clemens, of Frankfort-on-the-Main, has com- 
municated several articles to the Deutsche Kllnik, 1865— 

* The Lancet, Aug. 21st, 1875, p. 267. 



AIRS, GASES, VAPORS, AND FUMES. 177 

66, on the use of the vapor from a chloride of copper 
by inhalation, and as a disinfectant. He asserts that 
it is an established fact, supported by experience, that 
workers in copper mines, and in copper fabrics, remain 
protected against the cholera poison. This led him 
to the employment of these vapors in the treatment of. 
cholera, in connection with the internal and external 
use of the remedy. The vapor is produced by heating 
a solution of the chloride of copper, a drachm to the 
pound of alcohol, with the addition of two drachms 
of chloroform. He has used it successfully as a disin- 
fectant in crowded hospitals, and it has proved effectual 
in epidemics of measles and scarlet fever. He has used 
the vapor by inhalation successfully in one case of pul- 
monary gangrene, and in two cases of pulmonary tuber- 
culosis. 

Hot Water. 

Last, and most important, we come to the vapor of 
hot water, so much employed to evolve the volatile in- 
gredients of the various remedial agents discussed in the 
preceding pages. 

It is well known that in many pulmonary complaints 
attended with more or less distress in breathing, advan- 
tage will ensue from continuous warming and moisten- 
ing the air of the sick-chamber with a current of steam 
rising from a vessel of water kept boiling for that pur- 
pose. The warm and humid air inhaled, acts upon the 
irritated mucous membranes with a soothing influence 
similar to that excited upon external inflammations by 
warm fomentations, and thus contributes to the general 
comfort of the patient. 

Direct inhalation of the vapor of hot water has long 



178 THE INHALATION OF 

been employed for local emollient purposes in the treat- 
ment of the various affections of the respiratory tract. 
It soothes inflamed tissue, cleanses the mucous surfaces, 
dislodges adhering secretions, relieves irritation, arrests 
cough, facilitates expectoration, and favors the resump- 
tion of impeded circulation. 

Sir John Pringle* attested the good effects he had ob- 
served in pleurisy and pneumonia from causing his pa- 
tients to breathe over the steam of hot water ; a practice 
recommended by Boerhaave and van Swieten, and con- 
firmed to him in repeated trials by Dr. Huck, who found 
it more beneficial when the phlegm was viscid, as well 
as more grateful to the patient, by adding a small por- 
tion of vinegar ; and the distinguished editor of the re- 
publication adds, in a footnote, that too much cannot be 
said in favor of this simple and powerful remedy, for he 
has seen patients snatched from the jaws of death by it. 
He directs that where a prompt effect is wished for, water 
should be poured upon a heated shovel, the vapor in 
which case is poured in a stream into the lungs. 

The vapor of hot water was strongly recommended 
in recent catarrhs by Dr. John Mudge.t This practi- 
tioner directed that the patient should keep his head 
under the bed-covers during the inhalation, the inhaler 
being placed beneath his arm-pit. In this way general 
diaphoresis was induced, in addition to the local effect 
upon the bronchial mucous membrane. 

The vapors of medicated waters are often employed 
medicinally by inhalation. Boerhaave employed the 

* Observations on the Diseases of the Army, with Notes by B. 
Rush, M.D., Philadelphia, 1812, p. 129. 

f A Radical and Expeditious Cure for a Recent Catarrhous 
Cough, London, 1780. 



AIRS, GASES, VAPORS, AND FUMES. 179 

vapor of water distilled over elder flowers, as a remedy 
in pulmonary catarrh. 

Dr. Thomas found the frequent inhalation of warm 
steam from an inhaler his most efficient agent of relief 
in asthma, 

Dr. Mackintosh recommended* the inhalation of hot 
vapor in croup, in bronchitis, and in scarlet fever. 

Dr. Eberle recommended warm steam, with chamomile 
flowers and a little ether, in asthma; and warm water 
and vinegar in cynanche tonsillaris and trachealis. 

Dr. Tweedief states that the inhalation of steam in 
some cases rendered slightly stimulant and alterative by 
the addition of camphor, turpentine, or the balsams, has 
been found useful in promoting secretion from the dis- 
eased membrane. He recommends, also, the use of 
sedatives, and antispasmodics, as belladonna, camphor, 
ether, and opium, by inhalation, in chronic laryngitis. 

Winteringhausen, though disapproving of fumigations 
as advised by Ben net, Mead, and others, acknowledges 
the advantages derived from the inhalation of the steam 
of hot water, medicated vinegar of squills, etc. 

Skoda| recommends the vapor of water in laryngitis 
and bronchitis; and John Hunter, both in the bronchitis 
of adults and of children. § 

In like manner the vapor of water is often impreg- 
nated with the volatile oils of certain aromatic herbs 
steeped in the water, such as arnica, chamomile, cheno- 
podium, sage, xanthoxylum, and the like. 

* Practice of Physic. 
f Diseases of the Respiratory Organs. 

X Allg. Wien. raed. Ztg., 1862, Nos. 16, 24, 26, 29; Walden- 
burg, op cit., p. 571. 

g The Lancet, 1869, September 24th. 



180 THE INHALATION OF 

Impregnated with essences, such as cologne and the 
like, the vapor of water is often of much service in 
various affections of the respiratory tract. 

In a personal letter (1867) from Dr. S. Waterman, 
Surgeon to the Metropolitan Police, New York, that 
gentleman has reported very highly of aromatic alcoholic 
inhalations. He says : " I have been in the habit for 
many years of making use of aromatic alcoholic inhala- 
tions, and I have no hesitation in saying that they are 
of the most signal service when properly employed. I 
have used for this purpose the best 'eau de cologne/ 
that of Maria Farina, which I mixed in teaspoonful 
quantities with boiling water on the stove in winter, 
and on a gas-stove in summer. It creates an atmos- 
phere highly impregnated with the aroma of the vol- 
atile oil contained in the preparation, and is willingly 
inhaled by the patient. I have used these inhalations : 

" 1st. In the more advanced stages of croup, when, from 
the imperfect decarbonization of the blood, the nervous 
powers begin to fail, and paralysis of the nerves of the 
lungs is to be feared. In this state the inhalations act 
as a local stimulant, invigorating the nervous power, and 
often overcoming that dangerous state when no other 
remedy would do so. That these inhalations exert, also, 
a beneficial effect upon the nervous distributions of the 
entire mucous membrane of the fauces, larynx, trachea, 
and bronchi, in these cases, I now entertain no manner 
of doubt. 

"2d. In bronchial disorders dependent upon a re- 
laxed state of the mucous membrane, these inhala- 
tions have often proved highly useful. For adults 
they may be continued for days and weeks. They 
sometimes cause violent cough ; but it is just in such 



AIRS, GASES, VAPORS, AND FUMES. 181 

cases, where they exert a stimulating effect upon the mu- 
cous surfaces, that their effects will be found salutary." 

The vapor of warm water has been found extremely 
serviceable in both sthenic and diphtheritic croup. Dr. 
Wanner* found it of great use^ Dr. Jennerf recom- 
mends inhalations of water vapor with acetic acid in the 
early stages of the sore throat in diphtheria; a wine- 
glassful of vinegar to the pint of boiling water. Oer- 
telj places his main reliance on vapor of hot water, in 
the local treatment of diphtheria, to promote suppura- 
tion and thus effect the removal of the exudation. 

In addition to the authors named, many others have 
recorded similar opinions of the efficacy of the vapor of 
warm water in croup and diphtheria. 

It is my own practice in severe cases of croup to 
keep up a continuous evolution of steam in the apart- 
ment occupied by the patient; providing, of course, for 
efficient ventilation by opening a window in an adjoin- 
ing room or staircase ; and I can cordially indorse the 
opinion as to the benefits claimed by others for this 
treatment. 

There are various methods by which sufficient evolu- 
tion can be maintained in the absence of special appar- 
atus which direct the. steam towards the patient. A 
large wash-boiler with clothes in it, which are raised out 
of the water every few minutes, is an appliance available 
in every house. Buckets of water, with hot bricks or hot 
bits of iron in them, may be renewed from time to time. 

* Du croup et de son traitement par la vapeur d'eau, Paris, 1834. 

f Diphtheria, Its Symptoms and Treatment, London, 1861, 
p. 66. 

X Ziemssen's Cyclopedia of Practical Medicine, New York, 
1875, vol. i. 

16 



182 



THE INHALATION OF 



The suggestion of Dr. Rush to pour water upon a hot 
shovel is not to be forgotten in an emergency. 

The croup-kettle devised by Dr. Pretty, or some 
modification of it, is an admirable apparatus for the 
systematic evolution of steam. 

Dr. Pretty's kettle, as described by Jenner,* is of tin, 
with a small aperture at top closed by a screw instead 
of an ordinary lid. A spout, three feet in length, pro- 
jects horizontally from the upper part of the kettle ; 
another spout projects obliquely upwards from near the 
bottom, ending in a spoon-like projecti on just under the 
slightly curved-down open mouth of the upper spout. 
The steam passes out of the upper spout, and the con- 



Fig. 15. 




Porter's Croup-Kettle. 



densed vapor drops into the little spoon, and is returned 
by the lower spout to the bottom of the kettle. 

The croup-kettle of Porter (Fig. 15) is a very efficient 



Op. cit., p. 67. 



AIRS, GASES, VAPORS, AND FUMES. 183 

contrivance, and can be very easily extemporized by any 
tinsmith. It consists essentially of a tin vessel to hold 
the water, which is heated by a spirit-lamp. A funnel- 
shaped tube in the cover reaches to near the bottom of 
the vessel and serves to admit the external air, while a 
long oblique spout gives egress to the steam, and allows 
of its being directed towards the mouth of the patient. 

Thus employed in croup, it is not unlikely that the 
supply of watery vapor prevents the congelation of pseu- 
do-membrane to a certain extent, and keeps the exudation 
in a fluid state; thus facilitating its expectoration. 

It is not improbable that all the benefit from the in- 
halation of warm vapor from slacking lime in croup acts 
in this way, affording moisture to the exuded matters, 
which in their congelation must part with some of their 
watery constituents; unless, perhaps, the particles of lime 
act mechanically in detaching membrane or prying it up 
so that the water can get beneath it. 

After the performance of the operation of tracheotomy, 
it has been found serviceable to maintain a warm and 
moist atmosphere about the patient. 

The value of inhalations of steam in cases of poison- 
ing by corrosive vapors has been submitted to the pro- 
fession by Samuel P. Duffield, Ph.D., who records a 
successful treatment of poisoning by bromine inhalation: 

" The corrosive action of the bromine was such that the glottis 
had closed with a spasm, and did not yield willingly. The patient 
was brought near to a steam-pipe, the mouth held open, and the 
steam thrown from some distance, so as not to burn him, into his 
mouth and over his face. It had the desired effect, and the patient 
was subsequently sent home. The steam inhalations were con- 
tinued for some time, and the patient recovered."* 

* Detroit Keview of Medicine and Surgery ; The Medical Rec- 
ord, New York, September 16th, 1867, p. 323. 



184 NEBULIZED MEDICAMENTS 



PAET II. 

INHALATION OF NEBULIZED FLUIDS, OR SPRAYS. 

Nebulized Medicaments 
and the Apparatus for their Production. 

Whoever has seen a waterfall strike upon a rock is 

aware that portions of the stream become broken by the 

concussion into a coarser or finer spray, which remains, 

for a short time, suspended in the atmosphere. A stream 

of water forced through a narrow tube against a firm re- 
ft o 

sistance will produce the same effect, as is sometimes 
coarsely seen in the more remote particles of the water 
as it is dashed from a building against which a fire- 
engine is playing. These remote particles, no longer in 
contact, are separated molecules, which, as soon as they 
alight, become condensed into drops. 

On this principle, it occurred to Auphan, at Euzet- 
les-Bains, in 1849, to break up the mineral water of 
that watering-place into a fine spray, for purposes of 
inhalation, by forcing a delicate stream to impinge 
against the walls of the apartment. The same system 
was adopted shortly after at Lamotte-les-Bains ; and 
subsequently Sales-Girons (in conjunction with M. de 
Flube, proprietor of the baths at Pierrefonds, a water- 
ing-place near Compeigne, and who first suggested the 
idea of pulverizing liquids without employing a blast 
of air), constructed an apparatus for converting these 
mineral waters into the finest possible spray, with the 
idea of more thoroughly preparing them for the treat- 



AND APPARATUS FOR THEIR PRODUCTION. 185 

ment of diseases of the respiratory organs. Sales-Girons 
presented his first paper on the subject to the Parisian 
Academy of Medicine, May 20th, 1856; and a report 
upon it was made, in September following, by Messrs. 
Patissier and Henry. A few months later, on December 
8th, 1856, he read a paper entitled "Memoire sur les inha- 
lations pulmonaires, et sur la chambre de respiration nou- 
velle de Pierrefonds" before the Hydrological Society of 
Paris, in which he described his inhalatorium, and con- 
tended that the spray penetrated deeply into the respi- 
ratory tract, retaining all the elements of the mineral 
water. Doubts were expressed by many of the mem- 
bers as to the effect of such penetration; and shortly 
after, experiments were instituted at the different spas to 
solve the mooted question. 

Sales-Girons's inhalatorium was a chamber seven metres long, 
four and a half metres wide, and three metres high, in which it was 
intended that several patients, from one to fifteen, should take inha- 
lations at the same time. During the inhalations the window of the 
apartment was kept open, and the condensed fluid which accumu- 
lated upon the floor was carried off by a waste pipe. The patients 
were prevented from being wet through by appropriate cover- 
ings. A suction pump outside of the chamber drew the mineral 
water up into a tube, which passed through a water-bath, heated 
to the desired temperature, and then entered into the chamber, 
where it terminated in a vertical cylinder, to the end of which 
was attached the pulverizer or apparatus for producing the spray. 
Six fine grooves in the cylinder, controlled by a stopcock, gave 
exit to as many strongly compressed streams of mineral water, 
which, striking with great force against a metallic plate at short 
range, were thence distributed in the atmosphere in the form of a 
fine spray.* 

* Therapeutique Kespiratoire ; Traite" theorique et pratique des 
salles de respiration nouvelles a l'eau minerale pulverisee, pour le 
traitement des maladies de poitrine. Par le Docteur Sales-Girons, 
Medecin-Inspecteur des Eaux Sulfureuses de Pierref-nds. Paris, 
1858. 



186 



NEBULIZED MEDICAMENTS 



MM. Patissier and Ossian Henry visited the inhalatorium at 
Pierrefonds, and reported to the Academy of Paris that they were 
satisfied that the sprays produced at that establishment contained 
all the elements of the original mineral water. Sales-Girons re- 
ceived a silver medal from the Academy as a recognition of his 
valuable addition to our therapeutic resources. 

Subsequently, Sales-Girons devised a portable appa- 
ratus, a pulverisateur portatif des liquides medicamenteux, 



Fig. 16. 







Sales-Girons's Pulverisateur Portatif. (From Lewin.) 

a, compression pump ; b, reservoir ; c, stream of fluid about to strike the but- 
ton which is concealed within the drum ; d, tube with stop-cock ; /, drum or 
cylinder in which the excess of spray is condensed ; g, waste-tube to carry off* 
the condensed fluid; h, manometer. 



AND APPARATUS FOR THEIR PRODUCTION. 187 

which can be used in any apartment, and through which 
any medicated liquid can be broken up into spray as 
fine as that produced in his inhalatorium.* A commit- 
tee, consisting of MM. Gavarret, Patissier, O. Henry, 
and Poiseuille, presented a favorable report on this ap- 
paratus to the Parisian Academy of Medicine. 

The convenience of such an instrument at once com- 
mended itself to those desirous of employing the new 
method of medication, and gave an excellent opportu- 
nity to its adherents and opponents for experiment at 
their convenience as to the penetration of the spray into 
the respiratory tract. This apparatus (Fig. 16) was 
manufactured by Charriere, of Paris, and is known as 
the first model of Charriere. It consists of a metallic 
vessel of the capacity of from eighteen to twenty ounces, 
which is to be filled two-thirds with the liquid intended 
to be pulverized. In the neck of this vessel there 
screws a compression pump (condensing syringe), which, 
by compressing the air above the liquid, drives the latter 
through a capillary tube against a convex button, in 
close proximity, with such force that it is from that 
point deflected off in a fine spray. A manometer at- 
tached to the instrument indicates the amount of pres- 
sure employed, the usual pressure being a force of from 
three to five atmospheres. 

A second model of Charriere differs from the first in 
the reservoir being made of glass, and the glass tube 
through which the stream of fluid is forced, dipping down 
into the fluid. 

In a third model of Charriere, water pressure is used 

* Traitemont de la phthisie pulmon&ire par l'inhalation des 
liquides pulverisees, et par les fumigations de goudron. Paris, 1808. 



188 NEBULIZED MEDICAMENTS 

instead of compressed air; but, the pressure soon giv- 
ing out, it requires to be kept in motion more fre- 
quently. 

Later, M. Mathieu (de la Drome) constructed a port- 
able spray-producer according to a principle suggested 
by H. Tirman, and which consists in the forcible extru- 
sion of air and fluid at the same time. The principle 
will be recognized by taking an ordinary syringe after 
it has just been discharged of its contents, drawing back 
the piston, and then projecting it forward with force. 
The fluid remaining in the nozzle will be forcibly 
ejected with the escaping air, and will be converted into 
spray. 

It may be mentioned, in passing, that a syringe thus handled, 
or the little gum-ball douches, now used for nasal, aural, and 
urethral injections, taking up but a drop or so of liquid and then 
propelling it out with great force, affords an excellent method of 
medicating locally the palate, tonsils, pharynx, etc. The smaller 
the aperture of the nozzle of the syringe, the finer will be the 
spray. 

Mathieu's apparatus was exhibited to the Parisian 
Academy of Medicine on the 9th of May, 1859,* and 
is called by him a Nephogene, or, as properly anglicized, 
a nebulizer, a more correct name for these instruments 
than pulverizer or atomizer, the liquid being neither 
pulverized nor atomized, but simply broken up into a 
cloud or nebula. This instrument (Fig. 17) consists of a 
Heron's ball, in which the air is compressed. After the 
necessary pressure has been produced, the vent is opened 
by means of a stopcock, and the compressed air rushes 
out with great force; and, in escaping, drives before it 
and with it a small quantity of the desired fluid, which 

* Gazette des hopitaux, 1859, p. 297. 



AND APPARATUS FOR THEIR PRODUCTION. 189 

is allowed to drip into the exit-tube from a glass globe 
above ; and as it leaves the capillary opening at the ex- 

Fig. 17. 




Mathieu's Nephogene. (From Lewin.) 

a, compression pump ; b, glass globe containing the fluid to be nebulized ; c, 
exit-tube ; d, flexible tube conveying the condensed air from the reservoir to 
the exit-tube ; /, air reservoir. 

tremity, it emerges to all sides in a fine spray ; a lamp 
warms the spray as it escapes. 

There are several objections to the employment of 
this apparatus for inhalatory purposes. A large quan- 
tity of compressed air is forced out, and the liquid is 
driven into the mouth in a straight line, and with such 
force that the ordinary strength of an inspiratory effort 
cannot deflect it into the air-passages, and the greater 
part of it condenses upon the pharynx and soft palate, 
and sometimes strikes these parts with such violence (ac- 
cording to Lewin) as to cause spasmodic closure of the 
glottis and excite spasms of coughing. 

It is but fair to mention that this instrument was originally in- 



190 NEBULIZED MEDICAMENTS 

tended for administering a local spray bath to any individual por- 
tion of the body.* 

Similar instruments on the same principle have been 
constructed by Lambron, Velpeau, and others. 

Sales-Girons also constructed a third instrument, in 
which the spray is produced by the agency of bristles 
attached to the circumference of a wheel. As the wheel 
is rapidly turned, the brushes dip into the fluid to be 
nebulized, and as they emerge from it strike with force 
against a ledge, whence the fluid is disseminated as a 
fine spray. f 

Lewin, of Berlin, has constructed an apparatus with an 
ordinary suction pump (syringe) which forces the liquid 
into a reservoir, the air within which is thus compressed, 
and in its turn becomes a propelling force, driving the 
fluid, on the opening of a valve, out of a very fine aper- 
ture, whence it impinges on a convex button, and becomes 
thus broken into spray. This apparatus once set in action 
will continue to work for a considerable time without fur- 
ther pumping. 

WaldenburgJ has constructed an apparatus with a 
suction and forcing pump (the same sort of pump that 
is furnished with Mayer's uterine douche), which draws 
the liquid from a second vessel, and then drives it out, 
through a capillary opening, against a cylindrical drum 
with a concave plate of metal (a la Sales-Girons). A 
tube attached to the drum conveys the condensed excess 

* See Gaz. liebdom., May 4th, 1860, and, Mathieu's letter, May 
11th, 1860. 

f Gaz. hebd., May 3d, 1861. 

I Die Inhalationen der zerstaubten Fliissigkeiten, etc., von Dr. 
L. Waldenburg, Berlin, 1864; 2d edition, 1872, under the title: 
Die locale Behandlung der Krankheiten der Athmungsorgane. 



AND APPARATUS FOR THEIR PRODUCTION. 191 

of spray back to the reservoir, so that the same liquid 
can be used again and again for some time. "NValdenburg 
also conceived the idea of suspending the nebulized spray 
in connection with the vapor of water; and he adjusted 
a flask in which the water or desired decoction was 
made to boil, so that the steam passed through the cyl- 
indrical drum of his nebulizer and thus mingled with 
the spray. 

Subsequently he constructed, after a plan suggested 
to him by Reichenheim, a chemist, an apparatus in which 
the steam and the nebulized fluid was produced at the 
same time. A convenient vessel was tightly closed by a 
cork. Through an opening in the cork dipped a wide 
tube nearly to the bottom of the vessel. The tube, grad- 
ually narrowing, terminated at its bent extremity, outside 
of the vessel, in a capillary opening. The vessel, filled 
nearly full of an aqueous solution, being heated, a por- 
tion of the liquid is converted into vapor, and, as it 
cannot escape through the cork, it presses more and 
more by its continued evolution upon the upper surface 
of the fluid, and in its escape drives out some of the 
fluid before it through the exposed extremity of the 
tube dipping into the vessel. Then, by directing the 
escaping stream against some appropriate resistance, as 
a convex metallic lens, the simultaneous production of 
steam and spray may be kept up for a considerable 
time. 

Dr. J. Schnitzler* has constructed a special apparatus. 
This consists of a stout cylinder of glass, with an air- 
tight metallic cap and base : the air in the vessel which 
contains the fluid is compressed by a screw instead of a 

* Wiener Medicinal-Halle, 1862, No. 29; Fieber, Lewin et al. 



192 NEBULIZED MEDICAMENTS 

vertical piston, and when the cock is opened, after a few 
rapid turns of the screw have produced the desired pres- 
sure, the stream rushes out through a capillary tube, and 
impinges against a lens in close proximity. With this 
apparatus, the lens against which the fluid is nebulized 
can be held in the mouth of the patient so as to prevent 
too great a loss of fluid. 

Fourni6* has constructed an apparatus composed of a 
compression pump, and a reservoir with a stopcock; a 
glass cylinder with a tube ending in a capillary opening 
and made of platinum ; beneath the capillary extremity 
of the tube, a lens on which the impinging stream is 
nebulized. In this apparatus, also, the lens can be in- 
serted within the mouth, and the nebulization take place 
there. 

The most convenient apparatus working by pressure, 
next to that of Lewin, to be described presently, and for 
promoting deep inhalations of any fluid which will not 
be acted upon by metal, is the modification of Sales- 
Girons (Fig. 18), manufactured by L. Mathieu (cutler), 
of Paris. It is readily managed, and produces a more 
minute spray than any other instrument I have seeu em- 
ployed. 

An idea of the appearance of the nebula produced may be inferred 
from the exclamation of a boilermaker of this city, for a friend of 
whom I was employing an opiate solution at ordinary tempera- 
ture. He saw me take the cold water from a drinking pitcher and 
add it to the medicated solution, and, after watching the play of 
the spray for a few seconds, he burst out, " Well, Doctor, I'll be 
hanged ! that's the first time I ever saw any one get up steam out 
of cold water !" 

This apparatus (Fig. 18) is composed of a glass reser- 
* Gazette des hopitaux, July, 1861. 



AND APPARATUS FOR THEIR PRODUCTION. 193 

voir C, in which the liquid to be employed is poured 
through the little funnel G. On compressing the air in 

Fig. 18. 




Mathieu's Nebulizer. 
A, lever; B, condensing syringe; C; glass reservoir; D, joint in which there 
is a groove through which the stream escapes ; E, metallic drum, against the 
concave surface of which the stream becomes nebulized; F, waste-pipe; G, 
fuunel for entrance of fluid; H, screw regulating the delicacy of the escaping 
current of fluid. 

the pump B, by motion of the lever A, the fluid is forced 
through a small groove in one of the plates forming the 
joint d, and by turning the screw H ? the smooth plate is 
more or less compressed against the groove, thus regulat- 
ing the delicacy of the stream. A stream as fine as the 
finest hair can be thus secured if the instrument be 
properly constructed. This capillary stream strikes 



194 NEBULIZED MEDICAMENTS 

against the upper portion of the cylindrical metallic 
drum e, whence it is diffused in a very fine spray. A 
waste-pipe F, conveys the excess of fluid back into the 
reservoir. The force with which this little apparatus 
works is evident on removing the drum, when the stream 
will be projected up for several feet, then falling like a 
fountain. It is said that at a few inches distance the 
stream can be projected into the skin, thus forming a 
mode of endermic medication. 

All these apparatuses are composed entirely, or in 
great part, of metal, which limits their employment to 
such articles as will not chemically react upon them. 

This objection is overcome by the very admirable 
apparatus of Lewin, of Berlin (Fig. 19), which combines 
the Sales-Girons principle of the suddenly arrested 
stream, and the Nathanson principle of the distributing 
current of air. It consists of a strong glass reservoir of 
the capacity of one-fourth of a gallon, and is graduated 
in ounces. It is covered by a strong metal cap, in which 
there are three openings : one for the introduction of the 
liquid and the subsequent attachment of the condensing 
syringe; one affords exit to the capillary extremity of 
a slender tube which reaches to the bottom of the glass ; 
and the third is covered by a spring safety-valve, 
through which the compressed air may escape after a 
certain pressure has been produced. The finger is placed 
upon the capillary extremity of the exit-tube until the 
air in the reservoir has been sufficiently compressed by 
a few strokes of the piston, when the finger is removed, 
and the fluid rushes out with great force and breaks 
upon a gilded metallic convex button secured in a glass 
drum, perforated to admit the stream, and attached by 
a support to the side of the instrument. The drum is 






AND APPARATUS FOR THEIR PRODUCTION. 195 

not furnished with a waste-pipe, but is so inclined that 
the excess of fluid will flow over its edge into any con- 
venient receptacle. 

Fig. 19. 




Lewin's Glass Nebulizer. (From Lewin.) 
a, condensing syringe; b, reservoir; c, exit-tube; d, drum. 

The advantages of this instrument are, that the me- 
dicinal solution comes in contact only with glass, or with 
the gilded button, and therefore any substance desired 
can be nebulized with it ; that the amount of fluid nebu- 
lized, as well as the quantity remaining, can be accu- 
rately measured ; that twelve or fifteen strokes of the 
piston is sufficient to secure the escape of fluid for several 
minutes, thus avoiding the labor of frequent pumping 
during inhalation. 

The great objection to the apparatus is its extrava- 
gance with the liquid. Where economy is no object, it 



196 NEBULIZED MEDICAMENTS 

is the most convenient instrument for occasional office 
use. If any solution which may undergo change, or in 
which a precipitate may form, be allowed to remain in 
the reservoir, the capillary tube may become clogged 
up, and thus either stop the exit of the fluid entirely, or 
deflect the stream so that it will not impinge upon the 
lens. The exercise of care is necessary, therefore, to 
keep the instrument clean, and to avoid following its 
use with one medicine, by the use of another which may 
cause a precipitate. 

Various modifications of these nebulizers have been 
constructed on the same principle; very few of which are 
ever exposed for sale in the United States. They are 
not much used, and have been almost entirely superseded 
by another class of instruments, in which steam is used 
as the motive power. This lack of use, however, is, in 
my opinion, due to a want of appreciation of their merits 
on the part of the profession ; for they are exceedingly 
useful instruments, and in some classes of cases, prefer- 
able to all others. 

In 1862, Dr. Bergson constructed a nebulizing appa- 
ratus according to a suggestion of Dr. Nathanson,* 
which depends upon a physical principle similar to 
that of Mathieu. This principle is, that a strong 
transverse current passing over a perpendicular tube 
will rarefy the air in the upper portion of that tube, 
and thus draw up any liquid in which the tube may be 
immersed; the liquid, as it meets the current, being 
broken into spray. 

This principle was formerly applied to the cleansing of chimney- 
flues, and more recently has been employed for pumping bilge- 

* Deutsche Klinik, 1863, No. 7. 



AND APPARATUS FOR THEIR PRODUCTION. 197 



water from the holds of vessels, for distributing the water from 
fire-engines, and for superheating steam by the prompt evapora- 
tion of a watery spray forced within a boiler. It has of late y^ars 
become familiar to almost every one in the perfume distributors 
used by the ladies to odorize their handkerchiefs or any other por- 
tion of their attire ; and has been introduced into parlors and 
public places of amusement for the purpose of perfuming the at- 
mosphere. It is also an excellent mode of distributing a disinfect- 
ing solution in the atmosphere of a sick-chamber, or the wards of 
a hospital. 

The apparatus, as constructed by Bergson, consists of 
two pointed tubes at right angles, placed with their ex- 
tremities together, and so joined that the extremity of 
the perpendicular tube should stand in front of the axis 
of the horizontal tube, as seen in the accompanying 
diagram (Fig. 20). 

Fig. 20. 




The Bergson Tubes. 

If two tubes are thus arranged, and the vertical tube 
placed in a vessel containing a liquid, and then a current 
of air be blown from the mouth through the horizontal 
tube, the transverse current will carry over with it, as 
it were, the top of the column of air in the vertical tube, 
which, of course, will force up a current of the liquid to 

17 



198 



NEBULIZED MEDICAMENTS 



occupy the space of the air; and. this continuing, the 
liquid will at length reach the top, and be blown by the 
transverse current into a coarser or finer spray. The 
delicacy of the spray, and, consequently, its facility of 
ingress into the respiratory tract, will depend upon the 
minuteness of the extremities of the tubes, principally 
upon that of the tube dipping into the liquid. If the 
fluid is to be nebulized by the breath alone, the opening 



Fig. 21. 




Bergson's Apparatus with the Foot Bellows. (From Lewin.) 



a, reservoir for fluid ; b, waiter; c, vertical tube ; d, horizontal tube ; /.flexi- 
ble tubing; g, air reservoir; h, rubber compressor to be compressed by the foot; 
i, joint connecting the Bergson tubes; k, nebula or spray ; I, rim or cap of 
reservoir to which the nebulizing tubes are attached. 

of the horizontal tube must not be too small, otherwise 
force enough cannot be produced. If the current is 



AND APPARATUS FOR THEIR PRODUCTION. 199 

produced by means of a bellows, as the bulb of Davison's 
injecting syringe, the opening of the horizontal tube can 
be smaller. 

For the production of a continuous stream, an air 
reservoir must be attached to the tubing ; and, for this 
purpose, Dr. Bergson adopted the arrangement of a 
rubber bellows worked with the foot, connected to the 
horizontal tube by rubber tubing, in the continuity of 
which is placed a globular elastic ball as an air reservoir 
(Fig. 21). 

Later, Dr. Andrew Clarke, of London, adopted 
smaller bulbs, so that they can be compressed by the 
hand. It seems to me that the main advantage of the 
double bulb is, that pumping is thus rendered less labor- 
ious, for I do not conceive that there is anything to be 
gained for purposes of inhalation by the production of a 
continuous stream ; at times, indeed, rather the reverse, 
for the expiratory current regularly interrupts the inha- 
lation necessarily, and may thus cause a waste of fluid. 



CODMAN & 9HURTLEFF. 
JT BQSTDN. 



(Modification of) Clarke's Nebulizer. 

A, nebulizing tubes; B, mouth speculum ; C, bottle for medicated solution; D, 
rubber band-eompressor ; F, joint permitting the mouth speculum to be removed, 
or turned aside. 

A convenient arrangement for hand-use is shown in 
Fig. 22. 




200 NEBULIZED MEDICAMENTS 

Dr. G. J. Arnold, of Roxbury, describes* an appa- 
ratus in which he employs hydrostatic pressure as the 
propelling force. The horizontal tube of a Bergson 
apparatus is connected with the upper portion of an air 
reservoir by means of a stopcock and rubber tubing; 
another reservoir filled with water is placed at a higher 
elevation ; as the water from the latter flows into the lower 
portion of the air reservoir, the air within it is com- 
pressed, and when sufficient pressure has been obtained, 
the stopcock is opened, and the compressed air escaping 
through the horizontal tube produces the nebulization. 

It is not often that it is requisite to administer inha- 
lations in one's office ; but where this is done a great 
deal, it has been found advantageous by some practition- 
ers to employ a pneumatic reservoir, into which air is 
compressed by hand or steam, and kept under pressure 
so that it can be used at will. This saves the trouble of 
pumping during the use of the apparatus. Compressed 
oxygen, or compressed carbonic acid gas, may be kept 
in reservoirs for the same purpose in cases where the em- 
ployment of these gases is deemed advisable. I have 
used all these methods, at times, for nearly ten years, 
and find them very convenient, though their employ- 
ment, in my own practice, is chiefly restricted to using 
the sprays as douches to cleanse the pharyngeal and 
laryngeal surfaces from mucus previous to making 
topical applications. The use of the carbonic acid gas I 
have long abandoned, but still continue the use of com- 
pressed air and oxygen. 

A young French physician, whose name has escaped my recol- 
lection, first employed carbonic acid gas (in 1807, I think) by 

* Boston Med. and Surg. Jour., Dec. 27th, 1866, p. 434. 



AND APPARATUS FOR THEIR PRODUCTION. 201 

evolving it, as required, from a mixture placed in a vessel to which 
the horizontal tube is attached ; much in the same manner as now 
used for extinguishing fires by the gas. 

The tubes used in these nebulizers can be constructed of metal, 
glass, or hard rubber. Glass tubes can usually be cleansed by an acid 
bath, or by nebulizing through them a dilute mixture of sulphuric 
or muriatic acid and water, and then soaking them in pure water. 
If they become clogged, the best way to free them is by suction 
with the mouth at the larger end, so as to draw the obstructing 
matter back from the small end of the tube. If this does not suf- 
fice, or they become clogged while in use, a camel's-hair pencil, 
or a bristle, or a fine metallic wire, may be employed. A needle 
will be apt to break off the fine points. The tubes may be formed 
by drawing out glass tubing over the flame of a spirit or gas light, 
and then separating them by a scratch with the blade of a knife ; 
and if they are so joined that the points bear the relation to each 
other, shown in Fig. 20, they will work satisfactorily. If the end 
of the perpendicular tube be below the axis of the horizontal tube, 
the current will pass over it without impinging sufficiently to 
take the head off of the air in the vertical tube; and if it be too 
high, the current will pass to the side, or perhaps pass down the 
vertical tube, and cause the fluid to bubble up in the vessel. If 
the perpendicular tube be bent so as to run under the horizontal 
tube before dipping down into the liquid (see Fig. 27), the tubes 
can be nicely adjusted by cord or small sections of gum tubing. I 
had been in the habit of forming tubes in this manner for some 
time before I became aware that the modification had already 
been adopted by Prof. Winterich, of Berlin, and for the same pur- 
pose, that of gaining readier access within the cavity of the 
mouth. Indeed, the idea soon suggested itself to everybody of 
turning these tubes, after properly adjusting their points, so as to 
gain access to any desired point; and they have been curved into 
douches for the nares, anterior and posterior, the Eustachian 
tubes, the larynx, the bladder, the uterus, etc. 

The neatest nebulizing tubes I have seen are those 
originally made by Dr. Sass, of New York, for his own 
use, some years ago, and of late years furnished by most 
vendors of surgical instruments. They are made of 
strong glass, firmly cemented, the surfaces of contact 



202 



NEBULIZED MEDICAMENTS 



having previously been ground flat so as to secure firmer 
adhesion. The nebulizing tubes are inserted into tubu- 
lar reservoirs (Fig. 23), conveniently held in the hand 
when making the applications. A long personal use of 
this form of tube (a number of which, with tips turned 
in the various directions for applications to the larynx 
and the upper pharynx, were presented to me by Dr. 
Sass), has been in every way satisfactory. 



Fig. 23. 




Dr. Sass's Horizontal Nebulizer, with Tubular Reservoir. 



Dr. Lewin has devised a very convenient pocket nebulizer after 
the pattern of Bergson. The rectangular tubes are made of metal 
or of vulcanized rubber, and joined by a hinge, so that when not 
in use the two tubes fold one upon the other, and' take up but very 
little space. This is intended for use, as occasion may require, by 
blowing through the horizontal tube with the breath ; but such a 
method is rather applicable to other purposes than those of inha- 
lation, for the idea of another's breath being blown into one's 
mouth is disagreeable. To those who care to employ this method 



AND APPARATUS FOR THEIR PRODUCTION. 203 

I would suggest the attaching of a few inches of rubber tubing to 
the horizontal tube, so as to avoid close contact with the face of a 
patient, and to render the necessary effort less laborious. 

Dr. Mans* has made an improvement on the con- 
struction of these tubes of Bergson, which I have found 
to give at each compression of the pump, or hand- 
compressor, an amount of spray almost incredible to 
one who has not witnessed it ; and this with very little 
effort. This effect, though not more advantageous than 
the original tubes for purposes of inhalation, inasmuch as 
these latter produce spray enough, I have found extremely 
useful in cases of pharyngitis where I wished to employ 
the spray as a substitute for the gargle ; and this especi- 
ally in the throat troubles of young children, where the 
instrument which will do the most service in the shortest 
space of time is quite a desideratum. 

In this modification, the apparatus is made out of 
three tubes instead of two. The third tube communi- 
cates with the horizontal tube, and runs down behind 
the perpendicular tube the depth of a cork, in which the 
two vertical tubes run. Now, when the medicine vial 
is tightly corked, part of the transverse current presses 
on the surface of the liquid, and forces it up the perpen- 
dicular tube which dips into it, and thus the force that 
in the original tube- is exhausted in producing the vacu- 
um in the vertical tube, is reserved for the production of 
spray. I have had instruments thus arranged, duck- 
billed, after the manner of Winterich, and then curved 
so as to point to any desired portion of the pharynx, the 
whole of which, if desired, can be douched by a single 
pressure of the bulb. 

The spray producer of Dr. B. W. Richardson, of 

* Deutsche Klinik, June 16th, 1866, p. 224. 



204 NEBULIZED MEDICAMENTS 

London, introduced for purposes of local anaesthesia, is 
constructed upon the same principle as Mans's modifica- 
tion of Bergson 's tubes, but upon a different model. In 
both Mans's and Richardson's instrument the pressure 
continues for some moments after each compression of 
the bulb, which is not the case in the Bergson tube. 

Bergson has named his apparatus a Hydrokomion, the same name 
applied in 1829 by Schneider and Kudolf Walz to a sort of shower- 
bath apparatus, consisting of a reservoir containing water, the air 
over which was compressed by a pump, the fluid being driven out 
through many fine opening^. This last-mentioned apparatus, how- 
ever, was never intended for inhalatory purposes. 

The nebulized current from the Bergson apparatus is 
more powerful than that from apparatus on the Sales- 
Girons principle, and it can be at once directed into the 
mouth. It is therefore most suitable to diseases of the 
palate, pharynx, base of tongue, and lingual surface of 
the epiglottis. For the deeper structures, the other in- 
struments, the spray from which merely hangs suspended 
in the air, are more suitable, as they are less likely to 
elude the current of inspiration. 

Lewin, in conjunction with Bergson, constructed an 
attachment to his apparatus already described, by which 
the same instrument could be employed on the Bergson 
principle, and thus answer every indication. The drum 
and lens is removed from the apparatus (Fig. 19), and a 
rod and rings are attached, so as to support a graduated 
glass tube, terminating below in a very fine opening, 
placed directly in front of the capillary opening of the 
tube dipping into the reservoir. The glass tube is filled 
with the solution to be nebulized, which drips by gravity 
in front of the other opening. The reservoir contains 
nothing but air, and as this is compressed, the current 



AND APPARATUS FOR THEIR PRODUCTION. 205 

escapes, and the nebulization is thus produced. It is 
realty Bergson's tubes, upside down. 

In May, 1865, I exhibited to the Surgical Section of 
the American Medical Association a portable silver in- 
strument (Fig. 2 [), in which I had turned the Bergson 
tubes, as modified by Winterich, upside down, and 
screwed a little reservoir on to the large extremity 
of the perpendicular. tube, so as to make use of the 
same principle of gravity. Where glass tubes are 



Fig. 24. 




Bergson's Tubes reversed, with the reservoir on top. 



employed, the extremity of the perpendicular tube is 
blown out into a reservoir (see Fig. 27). If the fluid 
drips down too fast, — and that it will drip is an objection 
to the instrument, rendering its employment inelegant at 
certain times, — it can be regulated by the insertion of 
some porous material, or, in the metallic reservoir, by 
diminishing the size of the opening through which the 
fluid drops into the tube. This instrument is very use- 
ful in many cases. Patients can manage it themselves ; 
if of glass, can readily adjust the extremities of the tubes 

18 



206 NEBULIZED MEDICAMENTS 

so they will work ; and in applying nebulized fluids to 
the pharynx, etc., the vessel containing the fluid does not 
obstruct the view into the mouth. 

In all these apparatuses thus described, with the ex- 
ception of the Reichenheim-Waldenburg instrument, the 
spray, as it emerges, is too cold for general use in acute 
affections, unless the fluid employed is first warmed, or 
the spray produced and passed over a spirit-lamp, as in 
the apparatus of Mathieu, Fig. 17. 

It was, therefore, a happy idea of Dr. Siegle, of Stutt- 
gart, to employ steam instead of compressed air, as the 
motive power with the Bergson tubes, thus saving to 
the patient the necessity of an assistant, or the labor 
of frequent pumping; and securing a more constant neb- 
ulizing force than can be produced by the pump, from 
which the force gradually diminishes unless periodically 
renewed. 

Siegle attaches the horizontal tube to a small boiler. 
Underneath this boiler is a lamp. The boiler being par- 
tially filled with water and the lamp lighted, steam is 
evolved, and as it escapes through the tube, it creates 
the transverse current necessary to draw the fluid from 
the reservoir up the perpendicular tube, and then nebu- 
lizes it in the manner already described. The only pos- 
sible objection to steam as a motive power is that the 
nebulized fluid is always mixed with a certain amount of 
vapor of water, which it is possible, but hardly probable, 
might sometimes prove objectionable. The largest por- 
tion of the steam escapes in the surrounding atmosphere; 
very little is mixed with the spray; too little to prove 
objectionable. How small this quantity is will appear 
in the sequel. 

Siegle's boilers are made either of metal or of glass; 



AND APPARATUS FOR THEIR PRODUCTION. 207 

and each one, before it leaves the manufacturer, is tested 
to bear a pressure of at least two atmospheres. The 
boiler is furnished with a safety-valve to avoid explo- 
sion, and with one of Collardeau's thermo-barometers, 
gauged to two atmospheres, in order to indicate the 
pressure, which is regulated by raising or lowering the 
flame of the lamp by means of a screw acting on the 
wick. A stand sliding on the outside of the apparatus 
sustains the reservoir of the fluid to be nebulized by it ; 
and below this, another stand supports a small spirit- 
lamp, in order to raise the temperature of the liquid in 
the vessel above if necessary. For office use the appa- 
ratus may be furnished with a gas lamp, which is more 
convenient and less expensive, and a large boiler can 
be made to receive several sets of the Bergson tubes, 
so that separate tubes may be employed for nebuliz- 
ing such solutions, as of tannin, chloride of iron, etc., 
which are likely to form precipitates with other solu- 
tions. 

The most convenient form of Siegle's apparatus is 
that figured in the accompanying cut (Fig. 25) ; the 
whole closed in a metallic case, which still further les- 
sens the danger of bad results from an explosion. The 
horizontal tube passes down by an elbow into the boiler 
through a tightly fitting rubber stopper ; and the cork 
stopper in the opening through which the water is intro- 
duced does away with the necessity of any further safety- 
valve. The thermo-barometer is gauged to two atmos- 
pheres, but the apparatus will be set in action with a 
pressure of one-half atmosphere. The stronger the pres- 
sure, the more rapid the escape of steam, the more rapid 
the nebulization, and the stronger the propulsion of the 
spray. The desired pressure can, therefore, be readily 



208 



NEBULIZED MEDICAMENTS 



maintained by controlling the height of the flame be- 
neath the boiler. 



Fig. 25. 




Siegle's Steam Nebulizer. 

Various modifications of Siegle's Steam Hydroko- 
mion have been made by Lewin, Fieber, Burow, Pissin, 
Beigel, and many others; but they are ail on the same 
principle, and possess no advantage over his. 

Messrs. Codman & Shurtleff, surgical instrument 
makers of Boston, manufacture a very efficient and con- 
venient form of this apparatus (Fig. 26), which has al- 
most entirely superseded all the other instruments of the 
kind sold in the United States. It is carefully made, 
each boiler being thoroughly tested before leaving the 
manufactory, and it is supplied at a moderate price. 
This is the apparatus which for several years I have 
been in the habit of recommending to my patients, not- 



AND APPARATUS FOR THEIR PRODUCTION. 209 



withstanding my dislike to recommend patented instru- 
ments. 

Fig. 26. 




Codman & Shurtleff' s Steam Nebulizer or Spray Producer. 



A, boiler; B, steam-pipe; C, packing-box; D, nebulizing tubes; E, safety- 
valve, closing funnel-sbaped orifice for pouring in water ; F, wooden handle, 
for removing boiler from the stand, etc. ; G, socket for medicine cup ; H, support 
for boiler ; 1 1, base ; J, glass face shield ; K, elastic band, fastening face-shield 
to L, cradle ; N, mill-screw, to raise or lower face-shield ; M M, support for face- 
shield; 0, waste-cup. 

The only suggestions I have to make to complete this 
apparatus, and the remark applies to all of the same 
class, is that the boiler should be provided with a water- 
gauge, and be arranged so as to admit of proper cleans- 
ing. An instrument of the kind, supplied with a water- 
gauge, has been made for me by Messrs. Codman & 
Shurtleff, and I find it of great service in indicating the 
quantity of water in the boiler. 

In all these forms in which the horizontal tube is bent 
so as to dip down into the boiler, every now and then, 
especially soon after the apparatus is set in action, the 
steam condenses at the curve, and as this is driven out 
by the stream behind, it spurts out hot water, which is 



210 



NEBULIZED MEDICAMENTS 



sometimes projected into the face or eyes of the patient 
with very unpleasant results, and sometimes renders 
them unwilling to continue the inhalation. This can be 
in great measure avoided by passing the horizontal tube 
directly into the boiler at the side close to the top, and 
thus avoiding the curve where the steam condenses. 
This is the form of instrument that I prefer, with the 
duck-bill form tubes, which permit of their being intro- 
duced within a mouth speculum, and thus avoiding 
considerable loss of spray. No safety-valve is considered 
necessary, inasmuch as an excess of steam would force 
out the cork, and thus escape without explosion. With 
this modification, the apparatus, originally constructed 
for myself in 1865, by Wilhelm & Newman, of Phila- 
delphia, as figured in the following cut (Fig. 27), is 



Fig. 27. 




Modified Form of Siegle's Steam Nebulizer, with Duck-bill Tubes. 

essentially the Siegle apparatus, having his original 
arrangement of a lamp with a screw for raising or low- 
ering the wick. A glass speculum, introduced well into 



AND APPARATUS FOR THEIR PRODUCTION. 211 

the mouth, protects the teeth, tongue, roof of the mouth, 
etc. ; and the tubes entering the funnel end of the specu- 
lum, the face and clothing are thus protected, a very 
desirable precaution in the inhalation of solutions of the 
nitrate of silver and the like. The condensed liquid, as 
it flows over the funnel extremity of the speculum, is 
directed into an appropriate receptacle, so as to protect 
the clothing and furniture. The instrument, with all 
its appurtenances, has long been supplied by Mr. Gem- 
rig, the well-known surgical instrument maker, of Phil- 
adelphia. 

When the medicated solution is allowed to drip, as 
from the tubes figured in the upper portion of the illus- 
tration, the spray is much coarser and more abundant, 
and much more suitable in the treatment of affections of 
the pharynx, especially those in which an insufflation or 
a douching is desirable rather than inhalation. 

Some of the face protectors have a tubular offset 
below, to which a piece of flexible tubing can be attached, 
and thus act as a waste-pipe to direct the excess. A 
very convenient combination of this kind, with the fun- 
nel or face protector attached to the apparatus, has been 
constructed by Dr. William Read, of Boston, which is 
very compact, and can be readily carried about securely 
packed in a tin box employed as a stand when the instru- 
ment is in use. 

Dr. Beigle, of London, also, has constructed a very 
useful face protector, a sort of concave plate, with a cen- 
tral aperture through which the spray passes, to be placed 
in front of the mouth of the patient. 

Dr. Beigle has also devised an admirable little pocket 
steam apparatus, suitable for travellers who desire to 
continue this method of medication. 



212 NEBULIZED MEDICAMENTS 

Lewin, Burow, and some others, prefer the horizontal 
tube to be of metal, with a holder, in which slides the 
glass tube intended to dip into the medicated fluid. 
This is an improvement, as the risk of breaking the 
horizontal tube is avoided ; and if the glass tube become 
broken it can be readily replaced by another, and easily 
adjusted. 

A few remarks are necessary concerning the indi- 
vidual advantages of the different varieties of nebulizing 
apparatus described. 

The steam nebulizer will fulfil the greatest number of 
indications. The spray being mingled with steam can, 
when inhaled at a distance, be drawn into the minuter 
ramifications of the bronchial tubes and into the pul- 
monary vesicles ; and the temperature of the spray can 
be maintained, when desired, at a moderate warmth. 

Hand-ball nebulizers, and all those working by com- 
pressed air or compressed gas, are not suitable for pur- 
poses of inhalation as much as for insufflation or douch- 
ing — that is to say, the force of the spray is such that 
little or none of it gets access into the lungs without 
great effort on the part of the patient. Besides this, no 
matter how warm the medicated fluid may be in the 
reservoir, heat is evaporated so rapidly when it is con- 
verted into spray that the temperature of the nebula is 
always very low, often too low to be employed at all ; 
and therefore unsuitable for use in many affections, and 
actually injurious in some. My own opinion is that the 
promiscuous use of this form of apparatus has done more 
than anything else to prevent a proper development of 
the method of local therapeutics under consideration. 

The class of instruments first invented (by Sales- 



AND APPARATUS FOR THEIR PRODUCTION. 213 

Girons and by others, on the same principle), and which, 
strangely enough, are almost entirely unappreciated 
in this country, furnish a spray which is not mingled 
with either compressed air or steam ; a spray which can 
be readily maintained at almost any desired temperature 
by using warm or hot medicated solutions ; a spray 
which plays so gently in the atmosphere that it can 
readily be inhaled, mingled with the normal inspiratory 
current, without special effort on the part of the patient. 
It is thus obvious that, under certain conditions, each 
variety of apparatus best fulfils a distinct indication. 

Experiments upon Men and Animals as to the 
Penetration of Nebulized Fluids into the 
Respiratory Passages. 

The report of Sales-Girons to the Academy of Medi- 
cine of Paris, as to the results obtained in his inhalator- 
ium, caused considerable sensation in medical circles ; 
and numerous experiments were instituted under differ- 
ent auspices, and with certain predilections in favor of 
the new method or against it, to determine whether the 
nebulized fluids really penetrate into the respiratory 
tract, and if so, to what extent. 

At first the number of these investigations was limited, 
because the experiments had to be carried on at the 
establishments where the method was being employed ; 
but as soon as Sales-Girons devised his portable instru- 
ments, investigation was further stimulated, and being 
rendered more convenient of execution, a great number 
of observers became engaged in the pursuit. The results 
of these experiments were duly published in the leading 
French journals, and, as the subject spread outside of 



214 EXPERIMENTS AS TO PENETRATION 

France, in other European journals. They have been 
recorded with more or less detail in the works of Wal- 
denberg,* Fieber,f Lewin,J aud others, and alluded to 
by every one who has written on this subject. As they 
are interesting, instructive, and suggestive, we will re- 
peat the account of them given in the first edition of this 
volume. 



Experiments with Negative Results. 

Prominent among observers reporting negative re- 
sults, was Prosper de Pietra-Santa, physician at Eaux- 
Bonnes, whose experiments were performed, in an inha- 
latorium arranged at Eaux-Bonnes, according to the 
principles of Sales-Girons, and partly in the presence of 
Poggiale, who had been appointed by the Academy to 
prepare a report on the subject. 

He experimented upon a goat, upon three rabbits, and 
upon himself and another observer. § 

He caused a young goat to breathe, for a quarter of 
an hour, an atmosphere loaded with the nebulized min- 
eral water of Eaux-Bonnes, to which a small quantity 
of common salt had been added. The animal was then 
killed, and a solution of nitrate of silver applied to the 
larynx and bronchi, but without evincing any reaction. 

He caused a rabbit to breathe a nebulized solution of 

* Op. cit. 

f Die Inhalation medicamentoser Fliissigkeiten, etc., von Dr. 
Friedrich Fieber, Wien, 1865. 

X Die Inhalations-Therapie, etc., von Dr. Georg Lewin, Berlin, 
1865. 

§ L'Union medicale, 1861, Nos. 43, 44, and 59; Gazette raed- 
icale de Paris, 1861, Nos. 14 and 15. 



OF NEBULIZED FLUIDS. 215 

sulphate of iron from the Sales-Girons apparatus, for a 
period of twenty minutes. The application of a test of 
cyanide of potassium failed to detect any iron in the 
lungs or in the larynx ; but succeeded in the isthmus of 
the throat, on the soft palate, and in one portion of the 
oesophagus ; the latter probably because the animal had 
swallowed some of the fluid. 

He held two rabbits within a short distance of the 
spot where the fluid was nebulized in the inhalatorium 
of Eaux-Bonnes. The animals were killed, and the test 
applied with nitrate of silver and with acetate of lead, 
but without evincing the slightest trace of reaction in 
the respiratory organs. 

M. Prosper de Pietra-Santa read his memoir before 
the Academy of Medicine, October 8th, 1861,* coming 
among other conclusions, as the result of his clinical 
observations and experiments, to the following : that the 
nebulized mineral waters do not penetrate into the 
bronchi ; that a considerable depression of temperature 
is produced at the moment of nebulization ; that a very 
considerable desulphurization takes place in the nebuliza- 
tion of these mineral waters ; and that the temporary 
alleviations observed, are due to the inspiration of the 
disengaged hydro-sulphurous gas. 

Rene Briau, physician at Eaux-Bonnes,f at the lab- 
oratory of the College of France, placed at his disposi- 
tion by Prof. Claude Bernard, on 31st January, caused 
a rabbit to breathe for twenty-two minutes close to the 
drum of a Sales-Girons apparatus, the nebulized spray of 
two litres (a litre is 1.0567 quarts) of a solution of cyanide 
of potassium; the animal remaining tranquil and breath- 

* Gazette hebdomadaire, 1861, p. 659. f Id., No. 15. 



216 EXPERIMENTS AS TO PENETRATION 

ing the whole of the liquid. Immediately after, the ani- 
mal was killed by section of the spinal cord. The test of 
a solution of the sesquichloride of iron was applied, and 
detected the presence of the cyanide salt in the larynx, in 
the trachea, and in the larger and smaller bronchi. Prof. 
Claude Bernard, who, with MM. Vella and Leconte, wit- 
nessed this experiment, raised the objection that the sub- 
stance employed is very readily and very rapidly absorb- 
ed into the blood, and that this fact could account for its 
presence in the respiratory tract ; and, at his suggestion, 
the urine, ureters, and kidneys were also tested, and the 
same reaction took place. Briau, therefore, did nofcon- 
sider the experiment conclusive. Lewin,* in comment- 
ing upon this experiment, very pertinently observes that 
the absorption into the system might have taken place 
through the delicate mucous membrane of the respiratory 
organ. 

Then reversing his experiment, Briau caused a rabbit 
to inhale a solution of the chloride of iron (a salt ab- 
sorbed with difficulty by the animal tissues) during 
twenty -six minutes; and the reaction gave again a posi- 
tive result. 

The 6th of February following, a small dog was held 
close to the drum and breathed tranquilly, for twenty- 
five minutes, an atmosphere in which two litres of the 
solution of the perchloride of iron was nebulized. In 
this case the test could detect no trace of the salt except 
in the mouth, the nostrils, and the pharynx. He then 
performed the same experiment with another dog, em- 
ploying the solution of the cyanide of potassium by in- 
halation, and the iron salt as the test. Surprised at the 

* Op. bit., p. 163. 



OF NEBULIZED FLUIDS. 217 

different results on two species of animals, so closely 
related, he immediately repeated his experiments upon 
another rabbit, and on applying the test, in a few min- 
utes the characteristic reaction occurred in the whole 
extent of the bronchial tract. 

Finally, Prof. H. Bouley (d'Alfort) placed at his dis- 
posal a horse, which had a carcinomatous tumor of the 
stomach; and on the 18th of February, with the assist- 
ance of M. Paoux, he experimented on this animal at 
the veterinary college. The horse, whose respiratory 
organs were intact, was placed horizontally, with his 
head on the same plane as the rest of his body. The 
experiment lasted an hour and a quarter, forty-five 
minutes being consumed in the inhalation of four litres 
of a solution of the sesquichloride of iron. After the 
animal was killed by section of the spinal marrow, the 
fluid which had been inhaled was detected in the nos- 
trils; but there was no evidence of its having penetrated 
into the bronchi, the trachea, or the larynx. Briau 
concludes that he can account for the success with the 
rabbits on account of the proximity of their glottis to 
the mouth, and that the fluid in condensing on the pos- 
terior walls of the pharynx flows down into the larynx 
and trachea. In this view he is sustained by Prof. 
Claude Bernard. 

Champouillon* directed an invalid to breathe, for half 
an hour, a solution of the chloride of iron. After the 
mouth had been thoroughly rinsed, the sputa were tested 
with cyanide of potassium, but no reaction was produced. 

Deloref caused several individuals to inhale nebulized 

* Gazette des hopitaux, 1861, No. 66. 

f Gazette medicale do Lyon, 1861, September 1st and 16th. 



218 EXPERIMENTS AS TO PENETRATION 

solutions containing iodide of potassium and tincture of 
iodine ; but found no trace of iodine either in their urine 
or in their saliva. 

Armand Rev* desired to employ an atmosphere more 
profusely loaded with spray or nebula than could be 
produced by the apparatus of Sales-Girons, and he con- 
structed an apparatus by means of which the capillary 
jets of water, projected by a vertical pressure of fifteen 
metres, were received perpendicularly upon the palettes 
of a horizontal turbine, very rapidly rotated in the di- 
rection opposite to that of the jets. He thus produced 
a very dense spray, but the whole of the water did not 
nebulize; a portion of it spurted about unpleasantly. To 
control this dashing he inclosed the apparatus in a wide- 
meshed net, but to his astonishment it caught the whole 
amount of the spray, which it condensed, and did not 
permit the slightest particle to pass through. Then he 
employed pasteboard, in which he made openings of the 
size and form of the human glottis, and again the whole 
of the spray was caught and condensed. 

After this he instituted some experiments upon ani- 
mals, the results of which were negative. 

The cause of these obstructions he attributed to the 
circumstance that these sprays are merely suspended in 
the air, and that therefore, as soon as any impediment 
interfered with their slight impulse, the nebulized par- 
ticles immediately collected and condensed into drops. 
Thus the inner surface of the cheeks, the roof of the 
mouth, palate, etc., being such impediments, they detain 
the spray, which falls in drops without gaining entrance 
into the larynx. But, as Lewin observes, he seems to 

* Union medicule, 1861, No. 139. 



OF NEBULIZED FLUIDS. 219 

have overlooked the fact that in inhalation the inspira- 
tory current, as it passes into the lungs, will deflect 
these light particles as they play in the atmosphere, and 
direct them towards the middle line of the open glottis, 
so that they will describe a sort of curve in their passage. 

Edouard Fournie was the most persistent opponent to 
the new method, and exercised a remarkable degree of 
ingenuity in devising crucial experiments to put to the 
utmost test the theory that the nebulized medicaments 
penetrated into the air-passages.* 

At a seance of the Academie des Sciences, held Sep- 
tember 16th, 1861, he read extracts from a work of his, 
entitled, " Memoire sur la penetration des corps pulver- 
ulents, volatils, gazeux, solides et liquides, dans les voies 
respiratoires au point de veu de l'hygiene et de la thera- 
peutique," in which he details his various experiments. 

In order to test the mechanical feasibility of such 
penetration, Fournie constructed an artificial respiratory 
apparatus. He bent at right angles a tube twenty-five 
centimetres long and two centimetres in diameter, and 
placed it through one of two openings in a flask, so that 
it dipped into a solution of sulphate of iron, with which 
the vessel was half filled. The free extremity of this 
tube terminated in a wide mouth-piece, which might 
represent the oral cavity. The other opening commu- 
nicated, by means of rubber tubing, with the nozzle of 
an exhausting syringe, furnished with a delicate valve, 
which would open as soon as the force exceeded that of 
the inspiratory force of the lungs of a strong healthy 
man. He filled a Sales-Girons apparatus with a solu- 

* Proceedings of Academie des Sciences, 1861 ; Gazette heb- 
domadaire, 1861, p. 626; Gazette des hopitaux, 1862, No. 9. 



220 EXPERIMENTS AS TO PENETRATION 

tion of the cyanide of potassium, and placed it at ten 
centimetres distance from the mouth-piece of the appa- 
ratus ; and at the same time that the nebulizer was put 
in action, the exhausting syringe was placed in motion 
rhythmical with the duration and strength of ordinary 
human inspiration. 

Although the fluid was thoroughly nebulized, the 
solution of sulphate of iron did not change color in the 
least. From this experiment Fournie came to the con- 
clusion that he had demonstrated that the solution of the 
cyanide of potassium could not be made to enter the flask. 

At a later date he instituted a different experiment. 
Having detached from a recent cadaver, a human larynx 
with the tongue, epiglottis, and pharynx, he attached to 
this a glass tube of the diameter of the trachea. Arti- 
ficial inspiration was produced by placing in the mouth 
of the experimenter a tube of rubber attached to the 
lower end of the artificial windpipe; and during the 
inspiration, the glottis was held open by means of serres- 
fines attached to the posterior crico-arytenoid muscles, 
while the watery spray from the pulverisateur was di- 
rected towards the larynx. It was seen in this experi- 
ment that the larger portion of the nebulized fluid 
struck on the pharynx, and was then and there con- 
densed. Another smaller portion fell down upon the 
epiglottis, which protected the opening of the glottis like 
a regular roof, and thence glided in great drops along 
the aryteno-epiglottic folds to gain entrance into the 
larynx. Not the slightest trace of the nebulized water 
could be seen upon the walls of the tube. 

This experiment was repeated with solutions sensitive 
to the most delicate chemical tests, and with similar 
negative results. 



OF NEBULIZED FLUIDS. 221 

Then Fournie experimented on himself. He took it 
for granted that if the nebulized fluids penetrated into 
the trachea and the bronchi, he ought to be able to detect 
their presence in the sputa expectorated immediately 
after an inhalation. Suffering at the time from an acute 
attack of bronchitis, he inhaled a solution of arsenious 
acid, five centigrammes to five hundred grammes of 
water. He selected this material because it is less 
readily absorbed through the tissues than others, and, at 
the same time, can be detected by reagents when present 
in the minutest quantity. 

He placed himself within five centimetres distance 
from the opening of the apparatus, and inhaled, to the 
best of his ability, with widely opened mouth, the entire 
solution of five hundred grammes. The matters expec- 
torated during the few minutes next succeeding, and 
amounting to four grammes, were dried upon a platinum 
capsule, incinerated with nitrate of potassium, and the 
product of combustion placed in contact with water 
acidulated with sulphuric acid, according to the process of 
Marsh ; but without producing any of the metallic arsen- 
ical rings on the porcelain. The reaction ensued, how- 
ever, as soon as one drop of the arsenical solution was 
added. 

A similar experiment, performed upon a young man 
laboring under a profuse specific bronchorrhcea, afforded 
the same negative result. 

On another occasion a concentrated solution of nitrate 
of silver was inhaled through a glass tube of three centim- 
etres diameter, employed in order to protect the mouth 
from discoloration. Laryngoscopic inspection, immedi- 
ately after the inhalation, showed the posterior wall of 
the pharynx tinged with the nitrate ; but the interior of 

19 



222 EXPERIMENTS AS TO PENETRATION 

the larynx retained its natural color. The sputa expec- 
torated immediately after, showed no evidence of the 
inhalation. 

A young man, twenty-four years of age, who had worn 
a canula for several years, in consequence of a fracture 
of the larynx, the result of an accident, was selected for 
an experiment. The condition of the young man's organs, 
as seen by the laryngoscope, was as follows: Above the 
vocal cords, everything appeared normal ; the cords 
themselves were colored red, having lost their brilliant 
mother-of-pearly tint; toward the posterior inferior 
third of the left vocal cord a small nodule was perceived, 
having much the appearance of a cartilage. The lesion 
had not interfered with inspiration, for the arytenoid 
cartilages separated properly and the laryngeal cavity 
expanded in the usual manner ; but expiration was so 
difficult that for its performance the tracheal opening 
was indispensable; the closure of the larynx during ex- 
piration seemed to be effected by the lesion in the cricoid 
cartilage, which had been the seat of fracture, as a result 
of which the crico-thyroid and posterior crico-arytenoid 
muscles had become paralyzed. A bunch of raw cotton 
attached to a thread was introduced into the trachea, and 
the pulverisateur set in action. During the inhalation 
the canula was closed by the finger of the patient, which 
was slightly raised during expiration ; and the solution 
employed was of iodide of potassium five grammes to 
five hundred grammes of water. After the inhalation, 
the cotton was withdrawn and tested with starch and 
with sulphuric acid, but afforded no reaction. 

A similar experiment was performed upon one of the 
female nurses of the Hospital Beaujon, who also wore a 
canula in her trachea, and with the same negative result. 



OF NEBULIZED FLUIDS. 223 

From these experiments, Fournie offered the following 
reasons to account for the non-penetration of the nebu- 
lized liquids : 

1st. The divergence of the watery particles in issuing 
from the apparatus. 

2d. The propulsion of the current from the apparatus 
in a straight line. 

3d. The curve of the trachea. 

4th. The proximity of the soft palate to the base of 
the tongue. 

5th. The involuntary contraction of the glottis. 

6th. The irritability of the larynx. 

Finally, he draws the following conclusions : 

1st. It is nevertheless possible, by this method, to 
induce a toxic effect upon the larynx, but one of short 
duration only. 

2d. The fluid can certainly penetrate into the air-pas- 
sages, but not with facility, nor in sufficient quantity ; and 
this only when the inhalation is performed with pecu- 
liar care, such as opening the mouth well, separating 
the base of the tongue from the soft palate, with the head 
inclined backwards to destroy as much as possible the 
rectangular curve that the windpipe makes with the oral 
cavity. 

In contradistinction to the difficulty or impossibility 
of inhaling fluids into the air-passages, he calls attention 
to the facility with which solid powders can be drawn 
by inspiration even into the remotest bronchi, in proof 
of which he cites the various experiments in which he 
demonstrated that such powders will pass completely 
through a tube twenty-five centimetres in length and 
two centimetres in diameter, and bent at a right angle; 
and he says that while the watery particles condense upon 



224 EXPERIMENTS AS TO PENETRATION 

the sides of the tube, solid particles are propelled by suc- 
cessive ricochetting to the very end of the tube. 

Fournie believed the sulpho-hydrogen gas, disengaged 
from the thermo-sulphurous waters, to be, by its direct 
contact with the seat of lesion, one of the principal agents 
in the cure of diseases of the chest. 

Lewin, in commenting upon these experiments,* calls 
attention to the circumstance that Fournie seems to have 
overlooked the important fact that the trachea and the 
bronchi, instead of being dry and smooth like the glass 
tubes used for experiment, are constantly moist, and 
more or less covered with mucus ; and that the pulver- 
ulent particles must possess a peculiar strength if they 
can ricochet over this moist mucus until they reach the 
bronchi. 

If powders penetrate into the bronchi they must be 
projected in a continuous line, for as soon as they alight 
on the moist surface they must become entangled and 
remain there. 

As Lewin says, in ignoring as conclusive Fournie's 
experiment with the exsected larynx, in which the epi- 
glottis is placed " like a regular roof over the entrance 
of the glottis," the epiglottis does not retain this posi- 
tion during deep inspiration, as can be demonstrated by 
laryngoscopic observation ; it becomes more erect. It 
is absolutely impossible to place the larynx of a cadaver 
with its pharynx, soft palate, tongue, etc., in the position 
which they assume during life in deep and voluntary 
inspiration. 

Experiments with Positive Results. 

The most extensive series of experiments were per- 

* Op. cit., p. 174. 



OF NEBULIZED FLUIDS. 225 

formed by Demarquay, surgeon to the Maison Munici- 
pale de Sante; and these it is, principally, upon which is 
based the favorable report to the Academie de Mede- 
cine.* 

These experiments were performed at the Maison 
Municipale de Sante in the presence of Profs. Poggiale, 
Beveil, Gobley, and Trousseau, MM. Mialhe, See, Pie- 
tra-Santa, Giraud-Teulon, and the students of the insti- 
tution ; and with the assistance of M. Leconte.f 

Demarquay experimented upon some eighty rabbits, 
upon a number of dogs, and upon the same female nurse 
at the Hospital Beaivjon, who was made the subject of 
one of the experiments of Fournie. 

The rabbits were caused to breathe an atmosphere 
loaded with the nebulized spray of a solution containing 
one gramme of the perchloride of iron to one hundred 
grammes of distilled water, the apparatus employed 
being that of Mathien (and Tirman). The snouts of the 
rabbits were held forcibly open by a suitable dilator. 
The experiments continued five minutes, with a few 
momentary intervals of rest. The animals had all been 
lively before the experiment; a number of them were 
killed immediately upon the conclusion of the experi- 
ment, and the remainder were saved. Upon testing the 
respiratory organs of the slaughtered animals with a 
solution of cyanide of potassium, the presence of iron in 
a greater or less degree, and in various degrees as re- 
spected the individual portions of the apparatus, was 
demonstrated in the entire respiratory tract, even in the 

* Gazette medicale de Paris, 1861, p. 616. 

f Bulletin de l'Aeademie, September 24th, 1861 ; Gazette heb- 
domadaire, September 27th, 1861, p. 627. 



226 EXPERIMENTS AS TO PENETRATION 

parenchymatous tissue of the lungs ; and the blue ting- 
ing became still more apparent upon the addition of 
acetic acid. In order that it might not be objected that 
the fluid ran down the tracts, the experiment was com- 
menced at the bronchial tubes and continued up into the 
larynx. In some cases the entire bronchial tree became 
blue; in others, some portions of the minutest bronchi 
remained uncolored. The chloride of iron was detected 
in the oesophagus and in the stomach in consequence of 
the swallowing of some of the fluid. Immediately after 
the death of the animals, and at intervals during twenty- 
four or forty-eight hours, sections of lung were placed 
in contact with a watery solution of cyanide of potas- 
sium, to which acetic acid had been added, w T hich de- 
monstrated the existence of the iron salt in the very 
cells of the lung. 

The animals which had not been killed were attacked 
with broncho-pneumonia, and some of them with regu- 
lar circumscribed pneumonia, within a period of from 
twelve to twenty-four hours; — a further proof of the 
penetration of the fluid. 

Similar experiments were repeated upon dogs, and 
with similar results, except that the nebulized fluid was 
not found in the parenchyma of the lungs. 

Upon one of these dogs Demarquay performed the 
operation of tracheotomy, and then caused it to inhale a 
solution containing one per cent, of tannin. The wound 
was tightly closed during the inhalation, which continued 
several minutes, and at its close he passed into the tra- 
chea a piece of paper which had been moistened in a 
solution of chloride of iron and then dried ; and the 
inky reaction soon appeared. 

In these experiments with the dogs, not only were 



OF NEBULIZED FLUIDS. 227 

their snouts kept forcibly dilated, but their tongues 
were drawn forwards by means of threads passed through 
the organ, to prevent any impediment to the entrance of 
the fluid by contact of the tongue against the soft palate. 

Demarquay experimented upon a female nurse in the 
Hospital Beaujon, who was compelled to wear a canula 
in her trachea. This is the same case upon whom Four- 
nie experimented with negative results. The laryngeal 
structures were very much contracted, and the patient 
could bear the withdrawal of the canula only for a brief 
period at a time. This female inhaled as best she could 
a weak solution containing one per cent, of tannin. 
During the inhalation the tracheal opening was closed 
by a strip of paper which had been moistened with a 
solution of the sesquichloride of iron, the paper being 
confined by adhesive strips, and the whole covered by a 
napkin. The mouth was placed at a distance of twenty- 
five centimetres from the distributing tube of a Ma- 
thieu's apparatus. 

The difficulties in this case were very great from the 
condition of the glottis, the position of the wound with 
considerable depression of tissue at that point, and the 
prominence of the sterno-cleido-mastoid muscles. Twice 
the experiment failed on account of the yielding of the 
paper and the adhesive plaster, and their partial detach- 
ment from the canula ; but, on the third attempt, De- 
marquay kept his finger applied over the opening, and 
the strip of paper was withdrawn colored black in con- 
siderable extent. 

Demarquay lays great stress on the result of this ex- 
periment, as being prominently favorable,* for if a 

* Gazette hebdomadaire, 1862, p. 391. 



228 EXPERIMENTS AS TO PENETRATION 

larynx so altered from its normal condition, as to be 
unequal without artificial aid to the admission of suf- 
ficient air to sustain life, would permit enough of the 
fluid to pass it, to be detected by chemical reaction, it is 
hard to conceive why a larynx in a normal condition 
would not afford much greater facility of penetration. 

At the seance of the Academie de Medecine of Paris, 
April 29th, 1862, Prof. Trousseau exhibited several sec- 
tions of the lungs of Demarquay's rabbits in which the 
penetration of the chloride of iron could be demonstrated 
even to the minutest ramifications of the bronchi. 

Ta vernier* experimented on himself with a solution 
of sesquichloride of iron, and cyanide of potassium. He 
employed the pulverisateur of Sales-Girons, and took in 
long and deep breaths. First, he inhaled the solution 
of tannin, and then that of the cyanide of potassium ; 
with each he experienced a sensation of cold in the chest, 
with some feeling of constriction, and a disposition to 
cough. After the inhalation, an examination with, the 
laryngoscope revealed that the larynx above and below 
the vocal cords, and the vocal cords themselves to a 
greater extent, were covered with a sombre layer, which 
was nothing else than Prussian blue. Then he rinsed 
out his mouth again and again until the water contained 
no more trace of the Prussian blue ; and after that he 
endeavored, by hawking and coughing, to bring up some 
mucus from the trachea or larynx ; this, at first strongly 
though irregularly colored, was afterwards followed by 
uniformly colored mucus, which, he had not the slightest 



* Experiences sur la penetration dans les poumons des poussieres 
liquides tenant en dissolution des reactifs eliniques ou des medica- 
ments. — Gazette medicale de Paris, 1861, p. 808. 



OF NEBULIZED FLUIDS. 229 

doubt, had been brought up from the minute bronchi, in 
contact with the pulmonary cells. 

Prof. Gratiolet, shortly after, repeated Tavernier's ex- 
periments upon himself, and reported similar results.* 

Bataille took advantage of a chronic inflammation of 
the mucous membrane of the respiratory organs under 
which he was laboring, and while endeavoring to cure 
this, experimented on himself, f He inhaled for a time 
a solution of the extract of rhatany, and then examined 
the parts with the laryngoscope. He found the mucous 
membrane of the larynx and trachea colored red. After 
a few hours this color had disappeared ; nevertheless, 
during the entire day he expectorated reddish sputa. 
Bataille concluded that the medicated fluid had pene- 
trated into the bronchi, for his reddish expectorations 
were of the character designated as " bronchiques." 

Moura-BourouillouJ experimented on himself, and on 
patients, with a black fluid. Examination with the 
laryngoscope discovered the traces of the fluid in the 
larynx and in the trachea. His experiments upon him- 
self he repeated in the presence of Poggiale. Not only 
did he demonstrate the presence of the nebulized par- 
ticles in the trachea, but also their actual entrance and 
passage through the glottis during inhalation, as ob- 
served with the laryngoscope. § 

Auphan experimented to discover how far liquids 
could be made to penetrate into the respiratory tract. 
With this view he injected into the trachea of a rabbit 
four drachms of a solution containing one per cent, of 

* Gazette bebdomadaire, 1861, p. 822. 
f lb., 18G2, p. 390. 
X- Gazette des bopitaux, 1861. 
g La Revue medioale, December 15th, 1861. 
20 



230 EXPERIMENTS AS TO PENETRATION 

iodide of potassium. No cough was produced. In ten 
minutes the animal was killed, and he tested the trachea, 
the bronchi, and the parenchyma of the lungs without 
producing any reaction with starch. In another experi- 
ment he killed the animal immediately after its conclu- 
sion, and there ensued a slight reaction. Auphan does 
not doubt the penetration of fluids into the respiratory 
tract, which, he thinks, absorbs the material employed 
very promptly.* 

Sales-Girons performed some experiments with an 
artificial respiratory apparatus which he constructed out 
of gutta percha, with a mouth, a soft palate raised up, a 
tongue depressed so as to expose a portion of the poste- 
rior wall of a pharynx which was bent at an obtuse 
angle, and below it, horizontally, at a distance of three 
centimetres, was a glottis, and a glass tube below the 
larynx, represented the trachea. When this apparatus was 
placed before a pulverisateur and inspiration was drawn 
through the trachea, the liquid penetrated into that tube; 
but if the tube was bent into an angle the spray was ar- 
rested at the first angle, and fell below in drops of water. 

Report on the foregoing Experiments to the 
Parisian Academy of Medicine. 
On January 7th, 1862, Poggiale, as chairman of the 
committee appointed to investigate this question, made 
an extensive and very interesting report to the Academie 
Imperial de Medetine of Paris, in which he reviewed the 
whole subject critically, and in which, in answering 
affirmatively the question, " Do the pulverized liquids 
penetrate into the respiratory tract ?" he based his con- 

* Gazette medicale de Paris, 1861, p. 315. 



OF NEBULIZED FLUIDS. 231 

elusions chiefly upon the experiments upon rabbits, made 
by himself and others, principally Demarquay. He even 
drew positive conclusions from the experiments reported 
as evincing negative results; showing that in Briau's 
cases the fluids were clearly proved to have reached the 
air-passages, although the animals had been allowed to 
breathe through the nose. He referred to the many 
causes of error in such experiments, arising sometimes 
on the part of the experimenter himself, who might lack 
the necessary chemical, physical, or anatomical knowl- 
edge necessary for accurate observation ; or from want of 
intelligence or skill of the assistants ; or from the nature 
of the apparatus employed ; or, finally, from the manner 
of managing the animals, their want of co-operation, their 
struggles, etc., etc. In alluding to the negative result 
from Fournie's experiment upon the nurse at Beaujon, he 
showed how the error in that case must have arisen from 
imperfect closure of the opening of the trachea during 
the experiment; inasmuch as Demarquay, in his experi- 
ment with the very same individual, had failed twice 
from such a cause, and did not succeed until the third 
attempt. Finally, he believed that the experiments of 
Fournie himself upon the penetration of powdered sub- 
stances into the air-passages proved the possibility of the 
entrance of pulverized fluids. 

Four months later, in the discussion before the Acad- 
emy, held April 29th, Durand-Fardel, who had been 
one of the first to doubt the penetration of these fluids, 
objected to a portion of Poggiale's views, and for him- 
self came to the following conclusions : that the fluids 
penetrated to a considerable extent in the subglottic 
region and in the trachea, but that such penetration as 
far as the bronchi had not been proved ; for everything 



232 EXPERIMENTS AS TO PENETRATION 

went to show that the traces were feebler as the parts 
were more distant from the glottis ; and that, if they 
did pass beyond the trachea, it was in snch small pro- 
portion as to deprive them of their therapeutic value.* 

Thediscussion was continued on May 6th, f when Trous- 
seau declared himself warmly in favor of the method, 
expressing some degree of surprise that a doubt as to the 
penetration of these liquids could be entertained, since 
the penetration of coal and other materials was a fact 
beyond dispute; and, upon an observation being made 
by an opponent that the larynx is a vigilant sentinel, 
denying entrance to foreign bodies, Trousseau replied : 
"It is a vigilant sentinel, perhaps so, but one that can 
be taken by surprise. When it cries out, ' Who goes 
there?' it is already too late; in other words, when 
cough occurs, it is because the liquid has already pene- 
trated into the larynx !" As further proof, he exhibited 
the lungs of a rabbit which had inhaled but five min- 
ntes, and in which not only could the penetration of the 
solution of the iron salt be demonstrated to have reached 
the parenchyma of the lungs, but further, to have left 
traces of the existence of a pneumonia excited by means 
of this inhaled fluid. "Why," said he, "the fluids may 
penetrate too much, and it is therefore a method of treat- 
ment demanding caution." 

Poggiale, in reply to Fournie's objections to his report, 
replied, that the experiments on men and animals leave 
no doubt as to the penetration of pulverized substances. 
The experiments of Fournie prove nothing, if compared 
with the results of those of Moura-Bourouillou. He 

* Bull, de 1'Acad. do m6d., 18G2, vol. xxvii, p. 752. f Ibid. 



OF NEBULIZED FLUIDS. 233 

did not object to Fournie's results with his various arti- 
ficial contrivances ; but contended that, as we have to 
deal with men and animals, it is with men and animals 
that we should experiment, and not with tubes and ves- 
sels which have not the elasticity or pliability of organic 
tissues. In regard to Durand-Fardel's objection that it 
had not been demonstrated that the liquids penetrated 
into the bronchial tubes, he brought forward the cases in 
which its presence had been detected in the lung-tissue; 
and Demarquay's rabbits, in whom it had produced pul- 
monary inflammation, for which reasons "the penetration 
in the bronchial ramifications is an incontestable fact." 

Poggiale's report also included the questions as to the 
change of temperature in the pulverized fluids in issuing 
from the instrument, the chemical alteration of the sul- 
phuretted waters by the process of nebulization, and the 
probable value of therapeutical results. 

The mineral waters of the various spas do undergo 
some change, but not so with artificial solutions. 

The result of the discussion was an almost unanimous 
acquiescence with the able report of Poggiale. 

Further Experiments in Germany, and 
elsewhere. 

The widely disseminated results of the French experi- 
menters, to which reference has been made in the preced- 
ing pages, soon stimulated similar investigation in other 
portions of the continent, and we have recorded the re- 
searches of various observers in Russia, in Germany, and 
in Spain. 

Dr. Friedrich Fieber,of Vienna, was the first to intro- 
duce the new method into Germany ; and, with the assist- 
ance of his brother, Dr. Carl Fieber, he repeated De- 



234 EXPERIMENTS AS TO PENETRATION 

marquay's experiments on rabbits and upon an indi- 
vidual with a tracheal fistule. These experiments were 
repeated before Prof. Sehroff, and confirmed the results 
of the French observer. 

His experiment upon the individual who had under- 
gone tracheotomy differed somewhat from that of De- 
marquay upon the nurse at the Beaujon Hospital.* This 
patient was a shoemaker, aged twenty-two years, of 
strong frame and healthy lungs, who had been received 
on September 11th, 1861, in the wards of Herrn Prima- 
rius Kolisko, and who was under treatment for typhus. 

October 3d, he was seized with dyspnoea, which, with- 
in a few days, increased to such an extent that on the 
9th instant he was transferred to the surgical wards, 
where, on the 11th, the operation of laryngotomy was 
performed. The patient recovered gradually, but was 
not able to dispense with the canula. 

Some three weeks after the performance of the opera- 
tion, an attempt was made to withdraw the canula for a 
few moments, but it had to be promptly returned; and 
even an experiment made to see how long he could bear 
a closure of the fistule could not be endured longer than 
from twenty to thirty seconds. 

On the 1st day of January, 1862, Pieber undertook 
to repeat upon this man the experiment of Demarquay; 
and the effort was attended with difficulties fully as 
great as those of his Parisian prototype. In the present 
instance the difficulty lay less in a contracted glottis, 
and a strongly projecting sterno-cleido-mastoid, than in 
the want of intelligence on the part of the patient, who, 
in addition, was excessively timid, and could not make 

* Die Inhalation medieamentoser Flussigkeiten, etc., p. 44. 



OF NEBULIZED FLUIDS. 235 

up his mind to submit to the inhalation until Fieber had 
himself inhaled before him. Even then he breathed 
with so much dread that the first two attempts remained 
fruitless ; but the third attempt, at which he was rather 
more skilful, gave a positive result, though not to a very 
satisfactory extent. At the fourth trial, however, the 
result was more or less similar to that obtained by De- 
marquay. Fieber employed one of Charriere's appara- 
tus instead of one of Mathieu's, as Demarquay had 
done, and the solution experimented with contained two 
per cent, of tannin. He did not place within the open- 
ing a piece of paper as a test, but saturated a strip of 
linen with the solution of the perchloride of iron, and 
the finger alone was sufficient to close up the opening. 
Fieber regrets very much that, on account of the many 
difficulties with which it was attended, he was compelled 
to forego a laryngoscopic examination at the conclusion 
of the experiment. 

Tobold* exhibited at the meeting of the Berliner 
medizinischen Geselschafi the lungs of rabbits upon 
which he had repeated the experiments of Demarquay, 
and with similar positive results. 

Schnitzler and Storkt experimented upon the servant 
of Dr. Stork, with colored solutions, of rhatany, Gam- 
peachy-wood, saffron, etc. ; and upon laryngoscopic ex- 
amination, to which the individual was thoroughly 
accustomed, the coloring could be detected far down the 
larynx, and in one instance could be followed into the 
trachea. 

* Deutsche Klinik, 1862, p. 211. 

t AYiener Medicinalhalle, 1862, No. 46; Fieber, p. 50; and 
Wochenblatt der Gesellsehaft der Aerzte, 1862, No 45; Lewin, 
p. 183. 



236 EXPERIMENTS AS TO PENETRATION 

These gentlemen also repeated the often-cited experi- 
ment of Demarquay, upon an individual who had under- 
gone tracheotomy some eighteen months previously, on 
account of the presence of some syphilitic tumors. The 
method of experiment was that already detailed in con- 
nection with Fieber's case. The first two trials failed, 
but the third, fourth, and fifth succeeded, the patient 
inhaling more quietly and deeply, and the strength of 
the solution being increased from one grain to five to 
the ounce. 

The same experiment was then repeated with a dilute 
solution of iodine, only the linen was not placed imme- 
diately in the tracheal opening, but was fastened to a 
probe and introduced concealed within a thin tube, so 
that having been pushed forward and brought in contact 
with the tracheal mucus, it could be removed again 
concealed within the tube ; the fragment then placed in 
a strong solution of starch assumed the light-blue color. 
Twice the experiment succeeded ; a third time it failed. 
These gentlemen also repeated Sales-Girons's experi- 
ments with an artificial respiratory apparatus, and with 
confirmatory results.* 

Lewinf contributes five experiments ; the first two of 
which were performed in the presence of Prof. Virchow: 

1. A middle-sized dog, bound in a towel, was held 
by one servant, and while another servant held the snout 
open, the animal was made to breathe the spray of a so- 
lution (1 : 100) of the perchloride of iron from a Mathieu 
Nephogene, great difficulty being encountered in holding 
the animal so that the spray could be kept directed into 
his mouth ; for he would forcibly turn his head sideways 

* Fieber, op. cit., p. 50. f Op. cit., p. 183. 



OP NEBULIZED FLUIDS. 237 

so as to keep his muzzle out of the line of the current. 
After the nebulization of twelve ounces of the fluid, the 
animal, whose eyes had become quite bloodshot in his 
efforts to free himself, was killed by section of the spinal 
cord. 

The peculiar black reaction with tannin could be dis- 
tinguished on the soft palate, the posterior pharyngeal 
wall, the posterior surface of the epiglottis, and at vari- 
ous spots in the trachea, principally on the lateral walls; 
but not at all in the bronchi or in the pareuchyma of the 
lungs. 

2. A more powerful animal was selected this time, 
and the following device was pursued to manage more 
easily the head and snout of the animal, and to secure a 
more favorable position for the experiment : One side of 
a chest was so cut out that when closed over the neck of 
the animal it was completely encircled, the head within 
the box ; in the opposite side of the box the delivery 
tube of the apparatus was admitted through a suitable 
opening, and through another small aperture Lewin 
watched the effect. The interior of the chest was soon 
filled with the nebulized spray, but the dog forced his 
snout downwards to such a degree that the penetrating 
particles of the fluid were principally received upon his 
nose and the upper part of his muzzle, and here con- 
densed without at all entering the mouth. The exami- 
nation, upon killing the animal directly after the experi- 
ment, gave a negative result in the larynx and in the 
trachea. 

3. A powerful rabbit was made to inhale six ounces 
of a solution of chloride of iron (2 : 100) at a distance of 
one foot from the apparatus, the muzzle being forcibly 
dilated. This animal also was very restless, as were all 



238 EXPERIMENTS AS TO PENETRATION 

the animals with which Lewin experimented. The 
tongue was allowed to remain quietly in the mouth, and 
it was observed to lay with its base so much in contact 
with the posterior wall of the pharynx as to occlude the 
entrance into the larynx. 

On examining the slaughtered animal, the fluid em- 
ployed was chemically detected upon the upper surface 
of the epiglottis, on the lateral borders of the lower sur- 
face of the epiglottis, and upon the protrusion at its thy- 
roidal attachment; but not in the trachea. 

4. The same experiment was repeated with another 
strong rabbit, the nostrils being compressed and the 
muzzle held open ; and with the same result. 

5. The same experiment was performed upon a feeble 
rabbit, which could be so held that the hands did not 
compress the abdomen and thus impede the respiratory 
process, as was the case with the other animals. 

In this case the fluid could be detected beyond the 
bifurcation of the trachea, but not far, and only with 
slight traces. 

In all his examinations upon the cadavers of these 
animals, Lewin took the precaution to open the bronchi 
first and proceed towards the larynx, so that no particles 
of fluid might flow from above downwards during his 
manipulations. 

Lewin, in commenting upon these results, acknowl- 
edges that experiments upon animals cannot definitely 
settle the question of the penetration of these fluids into 
the respiratory tract. There is a great difference between 
the voluntary well-directed inhalations of a patient, and 
the restless, uneasy, unnatural breathing of an animal 
under experiment, to say nothing of the effect of po- 
sition of the head, tongue, epiglottis, soft palate, etc. 






OF NEBULIZED FLUIDS. 239 

He also calls attention to the fact that the bronchi absorb 
readily, and that results may take place during life 
which cannot be demonstrated after death. 

Lewin's views are very similar to those of Durand- 
Fardel. 

Pathological Proofs of Penetration. 

Lewin* details a most instructive pathological case, in 
which, with Dr. Schulz, chemical assistant to Professor 
Frerichs, he found free iron in the interior of a cavity 
in the lung of a patient who, shortly before his death, 
had inhaled a solution of the sesquichloride of iron. 
This case is as follows : 

" A carriage-driver, Muller by name, aet. 48, whose mother had 
died with tuberculosis, had suffered from dropsy as early as his 
seventh year; whether ensuing upon an attack of scarlet fever or 
not could not be determined. After recovery from this illness, he 
asserts that he had remained perfectly well until shortly before 
Christmas, 1861. About this time, during rather a cold spell, he 
fell asleep upon his box, and on awakening became conscious of a 
strong drawing pain in the upper thoracic region of the right side. 
This pain gradually diminished without medical interference, and 
eventually subsided entirely. Shortly before Easter (April 20th) 
the patient contracted afresh cold, attributed to exposure in frosty 
weather. Since that time he had been expectorating a profusion 
of sputa, unpleasant to the taste, and producing scraping sensa- 
tions in the throat. 

"After some medicinal treatment, the amount of expectoration 
became moderated during the daytime, so that onlv after ni«rht, 
and particularly early in the mornings, the patient expelled the 
sputa, which retained their unpleasant taste and odor, but with 
less production of the scraping. 

"The patient sought admittance in the Charite, and on May 
14th his present condition was noted down as follows : 

"Patient rather strongly built, with moderately developed but 
rigid muscles. Color of skin normal ; enlarged and congested 

* Op. cit, p. 190. 



240 EXPERIMENTS AS TO PENETRATION 

bloodvessels to be seen upon the cheeks. Mucous membranes mod- 
erately congested. Can assume any position in bed, but feels too 
weak to remain up. 

" Throat well proportioned; its muscles slightly employed in 
costo-abdominal respiration. A swollen lymphatic gland, rather 
painful upon pressure, upon the scalenus muscle of the right side. 
The voice somewhat hoarse. No pain in the larynx. 

" Thorax, in general, well formed, with a slight depression in 
the region of the seventh rib, right side. The angle of Louis 
marked, the clavicular furrow deepened, and more so on the right 
side than on the left. Elevation of thorax tolerably normal, no 
difference to be detected between the two sides. 

" Percussion produces a tolerably high, lightly tympanitic sound, 
at the sixth rib of the right side, in the mammiilary line; and so, 
also, in the right supra-clavicular fossa. Behind, upon both sides, 
healthy resonance clear beyond the attachment of the twelfth ribs. 
All over the left side resonance clear, rather higher over the upper 
lobe than over the lower one. On the right side a tolerably intense 
dull sound, outwards from the eighth spinous process. Stronger 
fremitus over the whole of the right side than upon the left side, 
and especially over the region of dulness. 

u Auscultation : left and behind, vesicular murmur with some 
sonorousness and sibilance ; over the entire right side very loud 
moist rattling and scanty rales masking the vesicular- murmur. 
In front, very loud vesicular murmur on the left side, sharp bron- 
chial-like respiration upon the right ; expiration rather long ; less 
rattling and whistling than behind. 

" The patient did not cough very much during the examination. 
The cough is much greater at night than during the daytime, and 
is principally induced by change of position. Expectoration easy, 
with a small quantity of sputum brought up by each paroxysm of 
cough. There are no long-continued paroxysms of cough with 
expulsion of large masses of sputum. The sputum is of a grayish- 
green color, distinctly translucent, only here and there a few mu- 
cous shreds extend from its upper mucous stratum, through a 
watery middle stratum, to its tolerably homogeneous sediment. 

u The impulse of the apex of the heart could not be felt; the 
systolic heaving was diffuse. Cardiac dulness, normal. Sounds 
clear, the second sound somewhat flapping at the pulmonary orifice. 

"The radial artery somewhat serpentine in its course, of rather 
strong outline, weak beat, and slight tension. 



OF NEBULIZED FLUIDS. 241 

" Tongue with a thick gray covering, especially in its central 
portion. 

11 Laryngeal mucous membrane congested, somewhat swollen, and 
covered with viscid, adherent secretion. 

"Abdomen soft and rather flat; a large scrotal hernia on the 
right side. 

" Spleen and liver of normal outline. 

"Appetite rather active; thirst frequent. Alvine evacuations 
at intervals of two days. Urine cloudy, but without containing 
albumen. 

"Temperature 39.5 (C), pulse 96. respiration 36. 

"17th. Morning. Sleeplessness, moderate sweats, severe parox- 
ysm of cough the night previous. Ordered, Decoct, cinchonce 
(gij) with Acid, jjhosphor. 

" Evening. Temperature 40, pulse 104, respiration 28. 

" 18th. Morning. Temperature 38 5, pulse 96, respiration 40. 

" Patient prefers to retain the semi-recumbent posture, but 
without fear of dyspnoea. Thorax rather strongly and actively 
expanded. Expression of countenance quiet. Quantity of expec- 
toration some eight ounces, slimy, grayish-green in color, and 
covered with froth in profusion. 

" 19th. Morning. Temperature 38, pulse 96, respiration 44. 

"Yesterday evening, after an attack of dyspnoea, coughed up a 
good deal of blood, which has afforded considerable relief. The 
sputa during the day, again about eight ounces, of triple consis- 
tence as before; only the fluid middle portion is a brownish-red, 
instead of a grayish-green. J£. Plumb, acet. grs. ij, dose vj. 

"20th. Blood coughed up again, but the quantity cannot be 
determined. Towards noon deep inspiration produces a stitch in 
the right side, in the region of the right nipple, and extending up 
to the axillary region. Percussion-sound in the line of the right 
axilla, appears somewhat shorter than before. Ordered 10 dry 
cups over the affected region. 

" 21st. Temperature 38, pulse 128, respiration 44. Has again 
coughed up blood to the amount of four ounces. The stitch in 
the side and the dyspnoea have subsided. Ordered Plumb, acet. 
gr. ss., every three hours. 

" 22d. Temperature 39.4 ; pulse 120, respiration 44. Again has 
coughed up about four ounces of blood. 

"23d. Temperature 38.5, pulse 136, respiration 60. Profuse 
sweats, great dyspnoea, intensive cough. Strong haemoptysis to 



242 EXPERIMENTS AS TO PENETRATION 

the amount of about ten ounces. Treatment: Inhalation from 
Mathieu's nephogene, of Liquor Jerri sesquichlorati, at noon and 
towards evening, each time thirty drops in six ounces of distilled 
water. Patient rather short-winded, and so weak that it required 
great effort to make the inhalation ; still, he asserted that he felt 
much more comfortable after the inhalation than he had done be- 
fore it. He did not cough as much as before by a great deal ; the 
dyspnoea decreased; the amount of expectoration diminished in 
quantity and less sanguinolent ; the patient's countenance fresher 
and livelier; the speech clearer and stronger than before. To- 
wards evening, temperature 32, pulse 118, respiration 40. 

" 24th. Sleepless throughout the night previous, with severer 
sweat and cough. Expectoration much more difficult. Although 
respiration appeared performed in great part by the employment 
of the accessory muscles, there was no feeling of want of breath. 
The sputum amounted to three ounces, was translucent, the middle 
stratum dark brown, without any trace of pure blood discoverable 
in it. Death at 2 p.m. 

" Autopsy, May 26th. — Marked decrease of subdermoid areolar 
tissue; the cartilages of the ribs to a considerable extent ossified. 
On raising up the sternum there was exposed to view, underneath 
the first rib, a cavity from which flowed out a black fluid with 
blackish shreds of tissue. Both lungs strongly inflated ; the left 
one totally adherent ; the right one less so. From the bronchus 
of the left lung there gushed forth a muddy-brown fluid ; the lung 
itself large, loose, pervious throughout, only in the posterior por- 
tion strongly cedematous and hyperaemic, moderately strongly 
pigmented. The bronchi very narrow, even the larger trunks. 
The muddy liquid distributed pretty fully in the lower lobe. 
Mucous membrane moderately injected. 

" Upon the right side the adhesion was produced principally by 
thick fibrinous masses, under which the pleura appeared strongly 
injected. The lower portion of the upper lobe was con- 
verted INTO A SAC, WITH THIN WALLS FIRMLY ADHERENT TO 
THE THORACIC PARIETES, IN WHICH WAS FOUND THE SHREDS 
AND THE BLACK FLUID ABOVE MENTIONED, BESIDE SOME BLACK- 
ISH-RED lumps (blood-clots). The lower lobe rather adherent. 
Upon its cut surface were seen numerous prominent grayish-white 
infiltrations ; the remaining tissue was void of air, and on pressure 
allowed the escape of some of the muddy fluid. The middle lobe 
and the lower portion of the upper lobe showed broncho-pneu- 






OP NEBULIZED FLUIDS. 243 

monic infiltration, surrounded by oedematous tissue. The bronchi 
moderately large, and mostly filled with a brownish muddy-look- 
ing fluid. The vessels of the lungs free from adhesions, their 
inner walls strongly discolored. In the first rib, between the bone 
and the cartilage, there was a small space which did not appear to 
have been made artificially. These extremities of the rib appeared 
a somewhat muddy-gray, partly cartilaginous and partly striated 
tissue. Outside of it, communicating with the space, lay a small 
cavity, which was covered with reddish excrescences. The adhe- 
sions right at the first rib were rather strong, thick, and, in ad- 
dition, somewhat slanting. 

" In the larynx and in the trachea but little of the muddy fluid. 
The mucous membrane discolored. 

" In the heart much fatty blood. The right cavity rather large 
in comparison with the left. Valves normal. The pulmonary 
and aortic valves somewhat glazed. The aorta somewhat dilated 
above the semilunar valves. 

" On the border of the anterior sinus of Valsalva of the semi- 
lunar valve of the pulmonary artery, and towards the left, was 
discovered a small opening leading to a bloodvessel, which formed 
a small sac on the outer side of the aorta, and from which several 
branches coursed over the aorta; one of the largest of these com- 
municated, by a free vessel at the base of the left ventricle, with a 
small artery which arose, with a calibre of about a line, from the 
aorta, close to the posterior coronary artery. Close to the opening 
of the posterior coronary artery there was a still smaller aperture, 
from out of which air could be forced by blowing into the net- 
work of vessels described as originating from the pulmonary 
artery. At the commencement of the aorta there were a great 
many adhesions, chiefly rounded superficially. 

"The black-colored liquid found in the protected 
cavity in the lower portion of the upper lobe was ex- 
AMINED BY THE CHEMICAL ASSISTANT, Dr. SCHULZ, IMMEDI- 
ATELY AFTER THE AUTOPSY, AND SHOWED THE PRESENCE OF 
FREE IRON, AS ALSO DID THE BLACKISH CLOTS — OF COURSE BUT 

in small proportion. Here we have the strongest possible evi- 
dence of the penetration into the iung of inhaled nebulized 
fluids." 

Iii a somewhat similar case related by Prof. Zdekauer, 



244 EXPERIMENTS AS TO PENETRATION 

of St. Petersburg,* a patient died from debility shortly 
after the restraint of a profuse haemoptysis by inhalations 
of a strong solution of the chloride of iron. Every- 
where in the tissue of the lung Dr. Holm discovered iron 
in greater quantity than could have been due to the blood. 
As Fieber mentions in a footnote, this case proves the 
penetration of the fluid into the minutest ramification of 
the bronchi. 

AValdenbergf instituted a great number of ingenious 
experiments upon men and animals, not so much to prove 
the entrance of the material into the respiratory tract, of 
which ability he had no doubt, as to determine the quan- 
tity or proportion that thus penetrated, and also in what 
form they reached the parts, whether still as spray or 
condensed into drops ; but, for reasons that are obvious, 
he was unable to come to any satisfactory conclusion. 

Prof. Gerhard t, X of Jena, repeated a number of experi- 
ments upon men. He caused several invalids to inhale 
a chloride of iron solution, and shortly after, by the aid 
of the laryngoscope, he pencilled the larynx with a solu- 
tion of tannin. The laryngeal image showed the inky 
reaction on the apices of the arytenoid cartilages, and 
on the posterior surface of the epiglottis ; in one case, 
several dark spots could be seen upon the true vocal 
cords. In one patient, with a fistule between the hyoid 
bone and the thyroid cartilage, a paper which had been 
dipped into a solution of tannin was held in the fistule 

* Wiener med. "Wochenschrift, No. 30, 1861 ; Fieber, op. cit., 
p. 42; and Lewin, op. cit., p. 240; et al. 

f Op. cit., 1st edition, pp. 111-1G5. 

I Inhalation medikamentoser Fliissigkeiten. Ein Beitrag zur 
Localtherapie respiratorischer Erkrankungen. Von Rudolf Wiede- 
mann, Jena, 1862; quoted by Fieber, op. cit., p. 49. 



OF NEBULIZED FLUIDS. 245 

after a few inhalations of a solution of the chloride of iron 
had been taken, and the usual reaction of these salts ensued. 

Wedemann* records many clinical observations con- 
firmative of the question discussed. 

Semelederf found that after the inhalation of astrin- 
gent solutions, the secretions collected at several places 
in the larynx as whitish floccules, with a reduction of the 
capillary injection attendant on inflammation of the true 
and false vocal cords. 

Prof. NiemeyerJ states that the fact of the entrance of 
these sprays admits of no doubt. He had treated with 
markedly satisfactory results, chronic laryngeal catarrh, 
follicular laryngitis, and pharyngitis, etc., employing 
solutions of alum, tannin, and nitrate of silver. 

Dr. Morell Mackenzie,§ of London, stated at a meet- 
ing of the Royal Medical and Chirurgical Society of Lon- 
don, February 14th, 1865, that, in conjunction with Dr. 
Duchesne, of Woodford, he had performed some experi- 
ments upon pigs and dogs, and with positive results ; 
and Dr. Gibb expressed his conviction, based upon his 
own observations, that the fluids penetrated into the 
minutest bronchi. 

Besides the experiments above detailed, many others 
were instituted by different observers in various parts of 
Germany, in Russia, Spain, Great Britain, and elsewhere; 
but the results do not differ from those already recorded. 
The entrance of the nebula, upon voluntary inspiration, 

* Op. cit, pp. 30-43. 

f Woehenblatt der Zeitschrift d. k. k Gesellsch. der Aertzte in 
"Wien, 1864, No. 1, quoted by Fieber, op. cit., p. 51. 

j Manual of Special Pathology and Therapeutics, 6th edition, 
1865. 

I Med. Times and Gazette, 1865, No. 765, p. 213. 

21 



246 THE INHALATION OF NEBULIZED FLUIDS. 

into the larynx, can easily be demonstrated by causing 
an individual to inhale a colored solution, as of indigo, 
anilin, or the like, under circumstances favorable for 
penetration, and then examining the parts by aid of the 
laryngoscope. 

In these experiments it is desirable to secure as finely 
divided a nebula as possible, and its delicacy can be 
tested by using a colored solution, as of indigo, and 
allowing the spray to strike against a piece of unglazed 
paper, which will become more or less completely cov- 
ered, showing the degree of tenuity of the drops ; a plan 
first employed by Siegle, who binds up in his work a 
page on which is pasted two strips of paper thus sub- 
jected to two apparatuses, his own having produced a 
spray so fine that, the paper looks as if it had been dip- 
ped in the solution, so evenly is it colored. Another 
method of testing; the degree of subdivision, and which 
is applicable to any solution, is to allow the nebula, 
as it is produced, to strike against a pane of window 
glass, and notice the minuteness of the condensing par- 
ticles. 

Thus, in despite of the experiments with negative re- 
sults, we are led to the conclusion that nebulized fluids 
can be inhaled deeply into the respiratory tract; and 
that when failure occurs it is due to unfavorable posi- 
tion of the epiglottis, or an improper method of inhala- 
tion. 

The Inhalation of Nebulized Fluids. 

From what has already preceded, it is evident that 
the inhalation of nebulized fluids can be utilized in the 
alleviation and cure of disease ; and that the method 



THE PROPORTION OF NEBULA INHALED. 247 

greatly enlarges our store of resources in local treatment. 
It presents us with a means of affecting the system by 
absorption, without compromising the digestive powers 
of the alimentary canal, or interfering with them ; for 
the mucous membrane of the air-passages is much 
quicker to absorb than that of the stomach. Then, too, 
the attenuated form in which the remedy is presented 
secures a subdivision of labor, as it were, on the part of 
the absorbent vessels, so that an effect more prompt and 
sustained may be produced, than when the remedy is 
presented in bulk and thus subjected to gradual inges- 
tion. Finally, the absence of a digestive process secures 
the absorption of the remedy in the chemical form in 
which it is exhibited. 

It will be seen in the sequel, that the powers of ab- 
sorption of the pulmonic mucous membrane have been 
utilized for systemic medication in instances where idio- 
syncrasy or disease has prevented the administration of 
remedies by the usual avenue. 

The Proportion of Nebula Inhaled. 

It is difficult to estimate the proportion of nebula 
which reaches the larynx, trachea, and lungs. Experi- 
ments have been made by several observers to determine 
this point, but their results are only approximative. 

The following results were obtained by Beigel* with 
Siegle's apparatus : 

" If the boiler, which contains about eight ounces, is half filled, 
viz., with four ounces of water, and the lamp beneath lighted, the 
evolution of steam begins in about ten minutes. One ounce of 

* Op. cat., pp. 49-51. 



248 THE INHALATION OF NEBULIZED FLUIDS. 

fluid is then, between twenty-five to thirty minutes, turned into 
spray and inhaled. The quantity of condensed fluid, after the in- 
halation obtained through the tube of my screen, is about four 
drachms, the loss in the boiler one ounce. Half an ounce of med- 
icated spray was, therefore, mixed with one ounce of steam. About 
half of that quantity recoils from the screen into the air, while the 
other half reaches the mouth. Here, again, about half the quan- 
tity remains, to be either swallowed or spit away, whilst the other 
half, viz , about three drachms of mixture of steam and medicated 
fluid passes the glottis and penetrates into the respiratory tract. In 
respect to that mixture, the conclusion may fairly be drawn that 
it contains a far greater quantity of atomized fluid than vapor. 
Not only because it can be assumed, a priori, that the heavier par- 
ticles of the fluid are driven by the force of the blast into the mouth, 
whilst the lighter steam mixes very readily with the atmosphere, 
but because an anal) 7 sis of the fluid, obtained by condensation, 
shows that the original strength of the solution is diminished but 
little ; at least, it was so in solutions of common salt, which I have 
tested. The experiment, to show that the steam dissolves into the 
air, while the atomized clouds rush forth, can easily be made with 
my screen. The opening through which the patient inhales is 
closed, the apparatus put into action, and the condensed fluid 
gathered. If steam merely escapes, we find that after one ounce 
of water has been turned into steam, about twenty minims only 
have been condensed and gathered in the vessel, while it contains 
about six drachms, when atomization has taken place at the same 
time. The conclusion is, therefore, obvious, that the strength of the 
medicated fluid is altered but very little through its mixture with the 
steam." 

The probabilities are, that from one-twelfth to one- 
sixth of the fluid nebulized reaches the respiratory tract ; 
but we must allow for the absorption by the buccal 
mucous membranes of much that reaches the mouth and 
is there condensed ; and as the proportion differs much 
according to the manner of inhaling, the doses to be 
employed will vary according to the proportion appar- 
ently actually inhaled in any given case ; in determin- 
ing which, the physician will have to depend upon his 



THE PROPORTION OF NEBULA INHALED. 249 

own judgment after witnessing his patient's manner of 
inhaling. 

Dr. James Collins, of Philadelphia, has furnished me 
with the following result of some experiments instituted 
by him, in 1866, to ascertain the probable amount of 
nebula received into the system. 

A steam apparatus was used with the Bergson tubes. 
The amount of drippings collected were carefully evap- 
orated, and the residue weighed : 



Ferro-ferricyanide of potassium, grammes 2 
were dissolved in 2 ounces of water. 
Eesidue from drippings, 



Loss, 



Sulphate of copper, 

Residue in drippings. 



Loss, 



Bicarbonate of potassa, 

Residue from drippings, 



Loss, 



Nitrate of potassa, 

Residue from drippings, 



Muriate of ammonia, 
Residue in drippim 



Loss, 



grammes 1.445 
.555 



grammes 


2 




1.181 




.819 






grammes 


2 




1.545 




.455 


grammes 


2 




1.285 




.715 


grammes 


2 




1.845 




.155 



An analysis of the residue of fluid, containing chlorate 
of potassa 20 grains to the ounce, and deposited on the 



250 THE INHALATION OF NEBULIZED FLUIDS. 

sides of a mouth speculum which had been used in in- 
haling, resulted as follows : 

On speculum, grammes .058 

Kesidue of 4 ounces of fluid, . . 2.755 

Total residue, 2.813 



Original contents, 80 grains, . . grammes 5.183 



Loss, 2,370 



Immediate Effects of the Inhalation of 

Nebulized Fluids. 
If the nebula passes beyond the glottis, a peculiar 
sensation is immediately felt in the trachea and upper 
sternal part of the chest, according to the depth of the 
inhalation and the amount of permeation by the fluid. 
As facility of inhalation is acquired, this sensation will 
become diffused over a greater extent of surface. If the 
fluid nebulized be at the ordinary temperature, a sense 
of cold will be felt in the parts ; and if ice-water be in- 
haled the sense of cold will be very distinct. Some- 
times a sense of oppression, and occasionally of real 
soreness, is experienced, especially when, at a first at- 
tempt at inhalation, a strong solution as of an astringent 
or caustic is employed ; hence it will sometimes be found 
desirable to let a patient inhale some bland fluid at his 
first attempt until he becomes accustomed to the method, 
unless it be a case of haemoptysis, when it is better to 
proceed at once with the astringent. Haemoptysis has 
occasionally been induced by inhalation, having, as will 
be seen in the following pages, occurred under the ob- 
servation of Fieber. I have witnessed the same result. 
Dr. Da Costa* has seen from the inhalation of a strong 

* Essay on Inhalation, N. Y., 1866, p. 20. 



MANNER OF CONDUCTING INHALATIONS. 251 

solution of alum, asthmatic wheezing breathing very 
speedily produced, with loud, dry rales discernible at va- 
rious parts of the chest; the attack lasting from eight to 
ten minutes. Dr. Collins* has witnessed the same eifect. 

If discomfort arise during an inhalation, the process 
should be suspended, and the parts gradually accustomed 
to the procedure ; and if the effect should follow inva- 
riably, the method should be discontinued. 

Usually, the sensation is not disagreeable; the first 
few inhalations induce titillation of the glottis, provoca- 
tive of cough; but this soon ceases, and cough is not 
produced at subsequent inhalations ; and, indeed, in 
some instances, the inhalation does not produce any 
cough. As a general rule, there is cough at the conclu- 
sion of each inhalation, or shortly after it, attended with 
greater freedom and increased facility of expectoration. 

If there is inflammation of the upper air-passages 
with pain and soreness, the inhalation almost invariably 
affords an immediate feeling of relief; probably by sup- 
plying moisture to the parts, and of course as a topical 
effect also of the narcotic or sedative which may be 
employed. 

Manner of Conducting the Inhalation of 
Nebulized Fluids. 

The patient should sit at ease in front of the appa- 
ratus, the distributing-tube from which should be on a 
level with his mouth. Siegle recommends that the pa- 
tient lean the chest forward with the elbows or arms 
resting upon the edge of a table. I have found this po- 
sition in general the most suitable and convenient, except 
in irregular cases. Waldenburg recommends that the 

* Verbal communication. 



252 THE INHALATION OF NEBULIZED FLUIDS. 

patients should, when strong enough, stand up and take 
their inhalations ; but this position does not permit of 
as free an expansion of the chest, and calls off part of 
the muscular force of the auxiliary muscles of respiration 
for the maintenance of the erect posture, and, necessitat- 
ing frequent respiration, the inspirations are, of course, 
less deep. Lewin prefers that the back should be sup- 
ported, instead of permitting the patients to lean forward. 

As soon as the apparatus is in action, which, with the 
steam apparatus, will usually be in from three to five 
minutes after the application of the flame, — and sooner, 
if the precaution be taken to introduce hot water into 
the boiler, thereby saving time and alcohol, — the patient 
should be directed to incline his head a little backwards, 
thus bringing the oral and laryngeal -cavities more to- 
wards a direct line. The spray, with or without the 
intervention of a funnel or face protector, is then allowed 
to pass into the mouth of the patient, who should make 
deep and rhythmic inspirations and expirations. 

It is impossible to give precise rules as to the distance 
from the apparatus at which the patient's mouth should 
be maintained, or the time that shall be occupied in each 
inhalation. Differences suitable to each case, dependent 
on irritability of structures, aptness at inhalation, etc., 
will occur w T ith every individual. Usually a rather 
warm spray is more pleasantly endured at a first inhala- 
tion ; and therefore it is well at the beginning of each 
inhalation to place the delivery-tube at a distance of but 
from four to six inches from the mouth of the patient, 
and then gradually increase the distance to from twelve 
to twenty-four or more inches, as may be most suitable. 
If the laryngeal structures are very irritable, the first 
sitting should not occupy more than five minutes, and 



MANNER OF CONDUCTING INHALATIONS. 253 

the inhalation should not be repeated on the same day. 
As the parts become accustomed to the irritation, and 
the facility of inhalation increases, the period of each in- 
halation may be increased to ten or fifteen minutes, and 
it may be repeated from two to ten times a day, accord- 
ing to the indications. 

It will be found a better plan to designate a certain 
quantity to be inhaled as a dose, and gradually increase 
it, than to prescribe a certain number of inhalatory efforts, 
or a certain duration of time; as regard to either of these 
particulars distracts the attention of the patient. 

The temperature of the spray lessens with the increase 
of its distance from the apparatus. The force of the 
current is also diminished in like manner, but in a less 
degree ; this depending rather upon the rapidity with 
which the steam is formed, and the heat regulated, by 
altering the size of the flame. 

The following are the rules laid down by Siegle to be 
observed with his apparatus, provided with a thermo- 
barometer to indicate the steam pressure : 
, f Stream strong. Temperature high. 






Thermo-barometer 2°. * Distance 2-6 inches. 

e. g., In Croupous Laryngitis. 

Stream strong. Temperature low. 

Thermo-barometer 2°. Distance 1-2 feet. 

e. g., In Chronic Pharyngitis. 

Stream weak. Temperature high. 

Thermo-barometer 1°. Distance 2-6 inches. 

e. g., In Tuberculosis of Lungs and Larynx. 

Stream weak. Temperature low. 

Thermo-barometer, 1°. Distance 1-2 feet. 

e. g., In Haemoptysis. 

* Indicating a pressure equal to two atmospheres. 
22 



254 THE INHALATION OF NEBULIZED FLUIDS. 

In the apparatus of Sales-Girons and others, working 
by pressure, the temperature can be elevated by means 
of a flame placed behind the drum ; the current of the 
nebula creates a vacuum directly behind the point on 
which the spray strikes, and this draws the flame in- 
wards and heats the spray. 

It is difficult to lay down special rules which shall be 
applicable to every case ; and hardly necessary, inasmuch 
as every physician employing this method soon learns 
by practice to regulate the manner of inhalation so as to 
suit his cases. Practice soon enables a patient to inhale 
properly, and also to overcome the disposition to cough, 
which is sometimes very great at the commencement. 
Where difficulty is anticipated, or where patients mani- 
fest considerable concern, it will be best at first that they 
should merely be allowed to inhale the steam that issues 
from the apparatus ; or simply the spray of plain water, 
to which the medicated fluid can then be added gradu- 
ally. For the same reason the pressure of the steam at 
the commencement of a sitting may be moderated, gradu- 
ally rising to a higher degree of the thermo-barometer 
by enlarging the size of the flame. 

With patients who are more intelligent, but at the 
same time nervous, a somewhat similar management 
may become necessary. Such patients can sit at first a 
little sideways, so that the current streams by the side of 
the face ; then, as they become accustomed to it, they 
can bend forward from time to time so as to get the 
open mouth in the passing current, and then take in a 
deep breath of the spray from the side. 

With small children and bed-ridden patients, the ap- 
paratus can very readily be so placed that the current 
can be directed into the mouth of the patient while lying 



MANNER OF CONDUCTING INHALATIONS. 255 

upon his side. The pillows and adjacent bed coverings 
must be covered with some suitable material, in order 
to protect the bed from moisture. 

Larger children are most conveniently managed by 
taking them upon the lap in order to remove their 
anxiety, and showing them the movements of inhalation. 
In this manner children of three years of age soon learn 
to inhale with real enjoyment or childish delight in the 
process. 

Moura-Bourrouillou recommends holding the nostrils 
closed by means of the finger or some special contrivance, 
in order the better to secure penetration of the spray into 
the air-passages. This is useful in occasional instances, 
where a patient will not breathe through the open mouth, 
and persists in performing the respiratory act through the 
nostrils. Traube recommends that the patient should 
extend the tongue well out of the mouth ; and my own 
experience is confirmative of the usefulness of this posi- 
tion of the tongue, in cases in which penetration of the 
nebula is required as far as the trachea, or still farther 
down the respiratory tract. Siegle holds both of these 
directions unnecessary ; and quite the reverse, if the 
tongue is very fleshy, and seems to be much in the way, 
lessening the oral orifice, he directs the patient to keep 
it depressed himself with a knee-shaped spatula. The 
mouth speculum subserves the purpose of a tongue- 
depressor. 

The physician must by no means neglect to watch the 
first inhalations of his patient ; otherwise, after a few 
moments, the tongue will be allowed to bulge up so that 
its base will press back upon the soft palate instead of 
being flatly applied to the floor of the mouth, with the 
tip behind the lower incisor teeth ; or the head will have 



256 THE INHALATION OP NEBULIZED FLUIDS. 

assumed an unfavorable position, the mouth be no longer 
properly opened, the inspirations become less energetic, 
or too frequent, etc., etc. 

Siegle also recommends that, in the beginning, the 
patient take an inspiration as if he were going to gape, 
or inspire after a quiet prolonged articulation of the 
diphthong sound oe. 

At the close of the inhalation, the patient should 
cleanse the mouth and pharynx by gargling with fresh 
water. If, however, the inhalation has been taken for 
an affection of the mouth or pharynx, this gargling can 
be dispensed with, that the medication may secure a 
longer local effect. 

In concluding, Siegle cannot call too much the atten- 
tion of physician and patient to the following rules : 

1st. Take care that the temperature of the spray and the strength 
of its propulsion remain constant during the entire continuance of 
the sitting. This has reference to the patient's distance from the 
instrument, as well as the pressure as indicated by the thermo- 
barometer. 

2d. Never permit an inhalation to be taken after bodily exercise 
or mental excitement, so long as the temperature of the skin re- 
mains elevated, or the pulse or respiration disturbed. 

3d. Several hours must elapse between a hearty meal and the in- 
halation. 

4th. In affections of the pharynx the respiratory efforts of the 
patient need not exceed those of his ordinary breathing. In af- 
fections of the larynx, the windpipe, the bronchi, and the lungs, 
the force of the inspiration must be greater in proportion to the 
distance of the affected structures from the mouth ; the deepest 
inspirations being necessary in affections of the lungs. 

5th. Let the patient rest awhile from time to time during the 
inhalation ; and under no circumstances must the length of a sit- 
ting exceed a period not justified by the strength of the patient. 

6th. The excess of spray condensing in the mouth and accumu- 
lating, especially when not composed of harmless substances, such 



MANNER OF CONDUCTING INHALATIONS. 257 

as mere water, common salt, etc., must be expectorated into some 
conveniently placed receptacle. 

7th. Children and infants should not be out of view for a single 
moment during the inhalation. 

8th. After the inhalation let the patient, who will then begin 
to cough more than usual, remain quiet for a quarter of an hour 
before he leaves the apartment. 

9th. During the inhalation the patient should not be allowed to 
speak, nor should any conversation be held with him. His entire 
attention should be directed upon the inhalation. 

Before proceeding with a medicinal solution it is often 
well, especially with nervous patients, to begin with 
pure water, and gradually add the medicated solution 
drop by drop. In some cases, where even water could 
not be inhaled, Beigel has found advantage from em- 
ploying milk, after the inhalation of which for some 
time, he has been able to proceed with the desired 
remedy. 

With some children Hank succeeded by forming his 
solution into an emulsion, so that it was mistaken for 
milk, and thus inhaled more readily than if the subter- 
fuge had not been resorted to. 

Number, Strength, and Duration of Inhala- 
tions, ETC. 

The time which shall be devoted to taking an inhala- 
tion will depend upon the quantity of the medicament 
which is desired to be introduced at each sitting, and 
upon the special apparatus employed, the minuteness of 
the particles of the spray, and considerations of a similar 
character. The glass apparatus of Lewin has been so 
constructed as to nebulize two ounces of fluid in one 
minute by from forty-eight to fifty-two strokes of the 
pump ; and as he has found the most convenient quan- 



258 THE INHALATION OF NEBULIZED FLUIDS. 

tity for each inhalation to be forty-eight ounces, it will 
require twenty-four minutes to reduce this amount into 
spray. This will be found rather a tiresome sitting for 
most patients, and also very wasteful of the fluid, for 
Lewin's own experiments show that of the forty-eight 
ounces nebulized, but three ounces find entrance into the 
mouth of the patient; and therefore the strength of the 
solution must be so graduated as to contain in three 
ounces as much of the substance dissolved as is desired 
to be brought in contact with the mucous membrane of 
the pharynx, larynx, bronchi, etc. 

With the apparatus of Bergson, eight ounces are re- 
quired to be nebulized to introduce three ounces of spray 
into the mouth, which will occupy from twelve to fourteen 
minutes, and require about forty-eight compressions of 
the bellows or bag. With Mathieu's nephogene six 
ounces are required, consuming from ten to twelve min- 
utes. With Lewin's steam hydrokomion, four ounces, 
and twenty minutes. It is difficult to say how much of 
this spray goes beyond the larynx or into it. With most of 
the steam apparatuses it takes from ten to fifteen minutes 
to nebulize an ounce — the usual amount employed for 
one inhalation ; but by increasing the force of the steam, 
and enlarging the size of the capillary openings of the 
tube, the same result can be accomplished in from four 
to seven minutes. 

For acute diseases, usually three and four inhalations 
daily will be sufficient. More frequent inhalation will 
be requisite in croup and diphtheria. In chronic affec- 
tions one or two a day will suffice, and these may occupy 
from ten to thirty minutes each. 

When an inhalation is intended merely to reach the 
pharynx or upper portion of the larynx, the patient may 



ARTICLES OF THE MATERIA MEDICA, ETC. 259 

sit so that his mouth is within a few inches of the spray 
as it is produced, at which distance the force of the spray 
is too strong to be carried far out of a straight line by 
mere ordinary inspiratory effort; but if it is to reach the 
smaller bronchial tubes, he should be placed at a distance 
of about two feet, or even more with a good apparatus, 
in order that the molecules of spray, their own force of 
propulsion being exhausted so that they are merely sus- 
pended lightly in the atmosphere, may be carried in the 
inspiratory current to the deeper structures. 

Articles of the Materia Medica suitable for 
Nebulization. 

Any article of the materia medica soluble in water or 
in weak alcohol, is suitable for submission to the process 
of nebulization. Distilled water, rain water, and river 
or spring water that has been boiled, are the best ve- 
hicles for the solution. Hard water, by the substances 
held in solution, is apt, at times, to irritate a delicate 
respiratory mucous membrane. Oils, and solutions in 
glycerin, are also sometimes employed. A fine spray 
cannot be produced with them, inasmuch as the aperture 
from which the fluid escapes must be larger than for 
aqueous and spirituous solutions ; still, for applications 
anterior to the larynx they are much better adapted 
than ordinary pencillings or garglings, because, by the 
minute subdivision of particles, more complete contact 
is secured, as well as -a more continuous effect. 

The natural sulphurous waters are decomposed by 
this process, giving off their hydrosulphurous acid ; but 
the extemporaneous solutions usually employed are not 
thus altered. 



260 ARTICLES OF THE MATERIA MEDICA 

The materials used should be chemically pure ; and 
the solutions should be well filtered before using, in order 
that no sediment may accumulate to clog up the aper- 
ture through which the fine stream of fluid is forced. 

Simple pharmacy is more necessary to be observed 
here than in the administration of remedies by the 
stomach ; and it is best always to begin with as weak a 
solution as will suit the case, the substance employed 
to be selected with reference to its physiological and 
therapeutic influence upon the constitution, as well as 
for its topical effect. 

The absorptive power of the mucous membrane of the 
respiratory organs being much greater than that of the 
stomach, poisonous substances must be employed with 
great caution, and their doses be augmented very grad- 
ually. 

The strength of any solution to be employed will 
vary with the individuality of the patient, his distance 
from the instrument, the length of the. sitting, and simi- 
lar considerations. 

The list in the sequel comprises most of the remedies 
used for purposes of inhalation by the process of nebu- 
lization ; with the doses in which they are usually em- 
ployed, the diseases for which they are recommended, 
and, as far as could be ascertained, the authorities by 
whom they were first recommended. The nomenclature 
is, in the main, that employed in the latest (1873) edi- 
tion of the Pharmacopoeia of the United States. 

Sales-Girons considers inhalations in the form of 
spray indicated in acute and chronic diseases of the 
pharynx, larynx, trachea, bronchi, and lungs ; in nasal 
catarrh, in asthma, in tuberculosis ; also in acute ton- 



SUITABLE FOR NEBULIZ ATION. 261 

sillitis, pharyngitis, bronchitis, pneumonia, simple and 
pseudo-membranous sore throat, diphtheria, and croup. 
At first he employed the method in chronic affections 
only, and the earlier remedies resorted to were the sul- 
phurous waters of Eaux- Bonnes, Pierrefonds, de Labas- 
sere, etc. ; and inasmuch as the treatment was instituted 
at these various watering-places, the plan pursued was 
that the patients should drink one glass of the mineral 
water every morning upon the empty stomach, and af- 
terwards inhale a certain quantity broken up into spray 
by the pulverisateur. 

Subsequently he increased his materia medica by the 
addition of tar-water, salt and water, and solutions con- 
taining iodine and chlorine; and finally he added the 
emollients, sedatives, and antiseptics, the chloride of iron 
in cases of haemoptysis, and quinine as an antiseptic in 
the last stages of tuberculosis. The duration of the in- 
halation depended on the condition of the patient, the 
stage of the disease, and the nature of the remedy. In 
chronic affections of the respiratory organs, where sul- 
phurous waters, tar-water, and emollient remedies were 
employed, the sitting continued some twenty minutes, — 
the time ordinarily consumed in nebulizing a glass of 
the mineral water. The inhalations were given twice a 
day, the first one in the morning before meals, and the 
second towards evening. When deemed advisable, and 
well borne by the patient, a third inhalation was per- 
mitted in the afternoon. 

In presenting the following arrangement of remedies, 
no attempt has been made at systematic classification. 
Indeed, it would be difficult to adopt a classification 
which would be satisfactory, physiologically or thera- 
peutically, without having to go over much of the 



262 ARTICLES OF THE MATERIA MEDICA 

ground more than once, thus incumbering the volume 
unnecessarily. It is believed that the index will be found 
sufficient for the ordinary purposes of reference ; and 
therefore, although a certain amount of order has been 
maintained in the succession of some of the topics, all 
the applications of any one remedial agent have been 
included under the same heading. 

Water. 

Cold water is employed, according to indications, 
as a detergent, astringent, antiphlogistic, or styptic. It 
is a very grateful application in many inflammatory 
affections of the throat, especially in tonsillitis; allaying 
heat, supplying moisture, and cleansing the parts from 
secretion. Some patients prefer iced- water, but water 
below 60° is often cool enough to be agreeable. Prof. 
Zeitz* reported the best results in angina tonsillaris from 
nebulized iced-water; and his observations have been 
abundantly confirmed. Waldenburg believes that he 
has cut short many a commencing angina, in subjects 
predisposed to it, by adding ice to the medicated fluid 
he has employed. 

In haemoptysis, the inhalation of the spray of cold 
water or iced-water will sometimes serve to restrain the 
haemorrhage. It was first recommended for this purpose 
by Fieber,f who states that where it can be borne, the 
inhalation of the spray of cold water (8°-10° R.) suffices 
in slight cases of haemoptysis, and in cases of bloody 
sputa. Other remedies, however, are more frequently 
resorted to in this condition. 

Warm water is of very frequent and varied service in 

* Fieber ; op. cit., p. 106. 

f Allg. Wien med. Zeit., 1862, No. 16. 



SUITABLE FOR NEBULIZ ATION. 263 

the topical treatment of affections of the throat and 
respiratory organs. It can be employed as an emollient, 
detergent, expectorant, absorbent, stimulant, and seda- 
tive, according to the temperature of the spray and pro- 
longation of the inhalation. This spray affords one of 
the very best means of promoting secretion, of diluting 
viscid mucus or pus or other excretion, and of facilitating 
the detachment of these products from the mucous mem- 
brane of the air-passages. It is an immediately grateful 
application, as well as more remotely remedial in almost 
all forms of inflammation of the pharyngeal, laryngeal, 
and respiratory mucous membrane. It cleanses the 
parts from secretion, soothes their inflamed surfaces, and 
relieves pain. It is probably the main beneficial agent 
in most inhalations, no matter what the medicinal rem- 
edy it holds in solution. 

It has been found useful in corvza, acute or chronic. 
I have never tried simple warm water in these com- 
plaints, because I have preferred saline solutions; but it 
is easily understood how it will cleanse the surfaces and 
keep them in a healthier condition. 

In mild cases of simple sore throat, inhalations of 
lukewarm water will often suffice as far as topical treat- 
ment is concerned ; and they are often equally efficient 
in most other acute superficial inflammations of the 
pharynx and larynx. 

In acute catarrhal bronchitis, nebulized warm water 
often affords considerable relief, and increases the facility 
of expectoration. In chronic bronchitis, also, simple 
inhalations of warm or tepid water, and sometimes, in- 
deed, even of cold water, employed several times a day, 
for from ten to fifteen minutes at a time, will often, as I 
have abundantly proven in my own practice, yield re- 



264 ARTICLES OF THE MATERIA MEDICA 

suits that are very gratifying. The bronchial tubes are 
kept cleansed of mucus, expectoration is facilitated, and 
a gentle recuperative influence is exercised upon the 
mucous membrane. If desired, the water may be just 
impregnated, as it were, with benzoin, cologne, or toilet 
vinegar, to render the inhalation more agreeable, or to 
occupy the patient's mind with the semblance of a potent 
remedy. 

In the dry variety of the affection, bronchitis sicca, 
the inhalation of warm water spray is prominently indi- 
cated, and it will often be found to subserve a useful pur- 
pose by supplying the moisture so much needed. 

In the bronchitis of pulmonary phthisis, likewise, the 
inhalation of warm water spray will facilitate expecto- 
ration and afford relief; and it is frequently resorted to 
for this purpose in my own treatment of these affections. 

Siegle relates* a case of rheumatic aphonia in a stu- 
dent, in which the voice improved, day by day, under 
several inhalations daily of hot vapor of water, so as to 
leave nothing more to be desired on the eighth day. 

Inhalations of the spray of hot water have been found 
beneficial in the treatment of croup and diphtheria, as an 
agent in facilitating the expulsion of false membrane. 
I have not used the warm water spray, preferring to 
employ the copious evolution of the hot vapor of water, 
as expressed in a previous portion of this volume. 

Sieglef reports a very severe case of membranous 
croup with impending death, in a child two years of 
a^e, for whom he had tried all the usual remedies in 
vain. 



He was about instituting inhalations of nitrate of silver 



or 



* Op. cit., p. 71. f Op. cit , p. 60. 



SUITABLE FOR NEBULIZ ATION. 265 

tannin, when the rapidly threatening symptoms of want of air 
seemed to him to be less due to obstruction by croupal membrane, 
than to ineffectual attempts to detach the accumulating mucus; to 
assist these, he administered inhalations of warm steam, and very 
soon the patient began to spit out portions of the membrane. After 
an inhalation of a quarter of an hour, the child breathed more freely, 
and after twenty-four hours, — during which the inhalation was 
more or less kept up day and night, the child bringing up a good 
deal of mucus and shreds of croup membrane, which the mother 
removed from its mouth with her finger, — the life of the little pa- 
tient was saved. 

Dr. Wittmeyer, of Nordhausen,* proposed the inha- 
lation of nebulized water in the asphyxiative stage of 
cholera, in order to convey water promptly to the thick- 
ened blood, and thus render it more diluent, and capable 
of circulating more freely. 

In a memoir presented by Sales-Girons to the Paris- 
ian Academy of Medicine, t on respiratory therapeutics, 
and upon which M. Beclard has made a report, it is 
claimed that these inhalations may be safely resorted to 
in a great variety of diseases, for the purpose of pro- 
ducing constitutional effects, because the mucous mem- 
brane of the respiratory organs exceeds all other mucous 
membranes, including that of the small intestines as well 
as the stomach, in its powers of absorption, as a conse- 
quence of the rapid passage of the entire mass of the 
blood through the lungs, exposing, within the space of 
less than half a minute, almost every globule of that 
fluid to the action of any remedy, through the endos- 
motic action of an extremely attenuated membrane of 
great absorptive power. In proof of this capability of 
absorption, it is stated that twenty-five litres of water 

* Deutsche Klinik, Oct. 13th, 1866. 
f Gaz. hebd., No. 10, 1867. 



266 ARTICLES OF THE MATERIA MEDICA 

may be injected into the bronchi of a horse within six 
hours, and become at once absorbed without occasioning 
any sensible injury to the animal. 

There may, therefore, be good grounds for Dr. Witt- 
meyer's idea of conveying water to the blood promptly 
in states of asphyxia, by means of its inhalation in the 
form of nebula. 

Mineral Waters. 

Natural mineral waters were the medicinal agents 
first employed in the form of nebula or spray. This ap- 
pears to have been simply due to the circumstance that 
the method of treatment originated at "the springs." 
Beginning with the sulphurous waters, the alkaline and 
saline waters were soon brought into requisition for the 
fulfilment of various indications. 

Sulphurous Waters. — Some of these waters are warm 
and others are temperate. It is known that much of 
the sulphurous acid in these waters is lost in the very 
process of nebulization ; still, however, a sufficient im- 
pregnation remains to exert a gentle tonic influence upon 
the parts, if no more. In France, the waters of Pierre- 
fonds, Eaux-Bonnes, and Euzet-les-Bains, were those 
first employed ; then those of Schinznach, in Switzer- 
land, Wistinghausen, Baden near Vienna, Aachen, and 
so on. I do not know that the natural sulphurous 
waters in the United States have ever been administered 
in this way. 

These sulphurous waters have been recommended by 
Sales-Girons, in the hoarseness of chronic laryngitis and 
bronchitis, tonsillitis, so-called granular pharyngitis, fol- 
licular inflammation of the larynx and pharynx, apho- 
nia, spasm of the larynx, bronchial catarrhs, asthma, and 



SUITABLE FOR NEBULIZ ATION. 267 

pulmonary phthisis. Auphan recommended the waters 
of Euzet-les-Bains in pneumonic hepatization of recent 
or of non-recent standing; although, at the same time, 
he considered the inhalations contraindicated in cases 
with coexisting inflammatory fever.* 

Spengler has expressed the belief that these mineral 
waters restore the functions of the ciliary epithelium. 

They have also been recommended by the French 
physicians, in affections of the heart. 

Alkaline Waters. — These waters were first recom- 
mended by Auphan, in laryngitis and pharyngitis, with 
viscid secretion and troublesome expectoration ; and also 
in the first stage of phthisis. The waters of Ems and 
Vichy, and so on, have been employed in the same af- 
fections by Wistinghausen and others ; and the Ems 
water is said to be particularly useful in catarrhal in- 
flammations with scanty secretions. The principal me- 
dicinal ingredients of this water are bicarbonate of so- 
dium and chloride of sodium in minute proportions. 

Saline Waters. — The strongly saline waters are also 
much used for inhalation, largely diluted with simple 
water. Of these we may mention the waters of Kissin- 
gen, Baden-Baden, Reichenall, Ischl, and so on. They 
have been used with more or less success in chronic 
superficial, non-specific, inflammatory affections of the 
respiratory passages generally. 

I have no personal experience with the use of mineral 
waters by nebulization, except in a few instances in 
which they were of no greater use than extemporaneous 
solutions of their chief ingredients in similar proportions. 

* Siegle, op. cit., p. 85. 



268 ARTICLES OF THE MATERIA MEDICA 

Carbolic Acid Water. 

The ordinary carbonic acid water of the shops, so 
much used as a summer beverage, forms an agreeable 
refrigerant and slightly stimulating inhalation in many 
cases of sore throat in general. I have had quite satis- 
factory results from its frequent employment in cases 
produced by misuse or overuse of the voice, especially of 
those who use the voice loudly in the open street or in 
large and crowded apartments. 

Glycerin. 

Dose. — A few drachms to an ounce, undiluted, or di- 
luted with from one to ten parts of water. 

This remedy is often employed as an emollient to 
relieve irritation in inflammatory affections of the lar- 
ynx, trachea, and bronchi, of whatever nature. It is 
likewise used in the cedematous conditions of the larynx 
ensuing in the course of the chronic laryngitis of phthis- 
is and of syphilis ; often with the view of promoting 
exosmosis of the effused fluid, a theoretic result which 
practice has not often confirmed under my own not in- 
frequent experiments to this end. It is often employed 
with water as the menstruum for other remedies. Thus 
Demarquay has recommended one part of tannin with 
fifty parts of glycerin, and one hundred parts of water, 
to soothe irritation from inflammation of the pharynx, 
particularly if employed in the early stages. It is 
recommended by Dr. Scott Alison in laryngitis and 
tracheitis associated with hoarseness and loss of voice; 
by Stehberger in laryngitis, with inveterate hoarseness 
and impairment of voice; by Fieber in whooping-cough; 
and by Leiblinger in the dry cough of phthisis. Steh- 



SUITABLE FOR NEBULIZATION. 269 

berger has recommended glycerin highly in croup,* 
employed undiluted or slightly diluted with water or 
lime-water. This author has reported seventeen cases 
of membranous laryngitis following measles, cured by 
this treatment. The inhalations were usually kept up 
for fifteen minutes at a time, and repeated every hour or 
two hours. 

The antiseptic qualities of glycerin are sometimes suffi- 
cient to overcome the fetid odor so frequently exhaled by 
patients laboring under ulcerative affections of the palate 
and pharynx. 

Olive Oil. 

Dose. — Ten to thirty drops, with from five to fifteen 
grains of gum arabic, in emulsion, to the ounce of water. 

An emulsion of olive oil has been employed as an 
emollient in catarrhal inflammations, in dry cough, 
especially the cough of phthisis, in whooping-cough, and 
in bronchitis. (Fieber, Leiblinger.) It has been occa- 
sionally employed in emphysema and asthma. (Lewin.) 

Almond Oil. 

Dose. — Same as olive oil. 

The expressed oil of almond has been used in the 
same affections as olive oil ; and also in irritable coughs. 
(Lewin.) 

Cod-liver Oil. 

Dose. — Same as olive oil. 

Cod-liver oil has occasionally been employed in 
phthisis. It impregnates the air of the apartment too 
unpleasantly to be much used in private practice. 

* Der Croup und seine Bebandlung durch Glycerin-Inbala- 
tionen. Manheim, 1870. 

23 



270 articles of the materia medica 

Gum Arabic. 

Dose. — Ten to thirty grains to the ounce of water. 
Gum arabic has been recommended in the same affec- 
tions as the oleaginous emulsions. (Leiblinger.) 

Table Salt. 

Dose. — One to twenty grains to the ounce of water. 

One of the most efficient remedies for use by inhala- 
tion is common table salt. It is the chief sensible ingre- 
dient in many mineral waters, and probably the main 
remedial agent in the combination; the water, perhaps, 
excepted. It is very useful in catarrhal inflammations 
of the air-passages generally, promoting resolution, and 
acting: as a mild stimulant and detergent. 

It was first used extensively by Waldenburg, who 
attributes to it all the good effects produced by the in- 
halation of the various mineral waters in which it is a 
prominent constituent. Siegle also has used it exten- 
sively, and corroborates the observations of Waldenburg. 
Beigel sets the apparatus in different parts of the room, 
so as to get up a sort of artificial sea air in the atmo- 
sphere for a time ; and he recommends it by inhalation, 
as affording great relief in all stages of consumption. 

Lewin employs it in small doses to relieve cough and 
promote expectoration. 

Liebig recommends it (in combination with tannin) 
in chronic catarrhs with difficult expectoration. 

Waldenburg* considers table salt indicated principally 
in chronic catarrhs of the pharynx, larynx, trachea, and 
bronchi. He considers it the most useful of all reme- 
dies, in dry catarrhs especially ; as it not only excites 

* Op. cit., p. 261. 



SUITABLE FOR NEBULIZ ATION. 271 

the failing secretion, but at the same time diminishes 
the tumefaction of the mucous membrane. It is like- 
wise useful, in large doses, in emphysema and asthma 
resulting from chronic bronchitis. Waldenburg states, 
however, that salt is not to be recommended in acute 
catarrhs, nor in the acute exacerbations of chronic ca- 
tarrhs, as it irritates the mucous membrane, and thus 
does injury more frequently than service. 

This remedy, in moderate doses, is highly extolled by 
the same author in many cases of pulmonary consump- 
tion ; in torpid cases, chronic in their course, with little 
secretion, and no disposition to acute exacerbations of 
caseous pneumonia. In these cases, not only does it 
produce the local effects above mentioned, but it in- 
creases the appetite, and this, with the thirst excited, 
leads to the increased consumption of liquid and solid 
nourishment. 

Lewin* closes his record of cases of phthisis treated 
by the inhalation of sprays with one of tuberculosis of 
the larynx and lungs, in which the positively beneficial 
result of salt was remarkable, inasmuch as the tubercu- 
lous process in the lungs underwent retrogression. 

Judge K., of Bromberg, set. 39, of slender build, feeble consti- 
tution, and phthisical diathesis, is the offspring of healthy, sturdy- 
parents, still living.. His mother, however, suffers from cough. 
He has three sisters, and they are healthy. Of the exanthemata, 
he has had only scarlet fever in his seventh year. 

In 1841, after great exertion and exposure to cold, he contracted 
a "gastric nervous fever," from which he recovered after a period 
of six weeks, but of which he soon had a relapse which lasted 
another six weeks. Since this time he has remained weak and 
feeble. 

His present illness is attributed to an overheating followed by a 

* Op. cit., p. 45. 



272 ARTICLES OF THE MATERIA MEDICA 

cold, during an exhausting official sitting in 1855. The disease 
set in with chill, heat, fever, considerable cough, and subsequent 
emaciation. He then sought recuperation at Reinerz, where, by 
the use of its tepid springs, with the use of whey, he became toler- 
ably well again. While travelling, in the following year, 1856, 
the cough returned, and had since remained permanent without 
alteration. 

In the summer of 1862, the patient sought the mineral springs 
at Ems, and not without some benefit; but fourteen days after the 
treatment at that place had been discontinued, there set in a hoarse- 
ness with occasional small, lumpy, bloody expectorations. 

Soon after this he began to experience great difficulty in swal- 
lowing his food, so as to render the process very uncomfortable, 
and "he sate himself to his meals very reluctantly." The pain 
was felt principally during the first and third portions of the pro- 
cess of deglutition, and also by the passage of the bolus over the 
ulcerated epiglottis on one side, and the inflamed arytenoid carti- 
lages on the other. 

Present condition, June 2d, 1863 : The pitch of the voice is high, 
attenuated, and weak. The soft palate is redder in color than is 
normal. On the right side are many relaxed veins extending as 
far as the uvula. 

The circumvallate papillae are much enlarged, and project in a 
button-like manner. On the right side of the root of the tongue is 
a threadlike vein with lateral varicosed branches, extending almost 
to the anterior attachment of the epiglottis. 

The follicular glands are more swollen on the right side, less 
prominent on the left. Two very full glands, superficially ulcer- 
ated, are seen upon the glosso-epiglottic ligament. 

On the anterior border of the epiglottis, particularly the left side, 
extending beyond the middle line, is a loss of substance with the 
tuberculous characteristics. The border of this defect of the epi- 
glottis shows a small swelling on its free extremity where it ap- 
proaches the sound portion of the left side, and, rather more upon 
the inferior surface, a button-like excrescence. The inferior sur- 
face of the epiglottis in the neighborhood of this defect is yellowish 
and cicatrized, and the protuberance of the epiglottis can scarcely 
be seen. 

The ary-epiglottic fold is more swollen on the right side, and 
there is a small cicatrix upon the left one. The mucous membrane 
of the arytenoid cartilages is so oedematous from infiltration that it 



SUITABLE FOR NEBULIZ ATION. 273 

cuts off almost completely the view of the vocal cords, permitting 
only their anterior attachments to be seen, at which point their 
color is recldishly livid. 

The false vocal cords are dark-red in color, and very much swol- 
len, and on the right one there is a superficial erosion. 

The anterior wall of the trachea, as far as can be seen, is colored, 
as from a recently contracted catarrh. 

The larynx is painful to pressure. The neck is small, thin, and 
long. The contour of the thorax is flat, depressed, and paralytic. 
On the right side, beneath the attachment of the clavicle to the 
sternum, is a longish depression, and the whole region beneath the 
right clavicle is sunken in. Inspiratory elevation but slight. The 
panniculus adiposus gone. 

Percussion in the right supra-clavicular region elicits a dull, 
empty sound ; on the left side, it is normal. In the internal supra- 
clavicular region of both sides, the sound on percussion is alike, 
and normal ; externally, on the contrary, it is clearer upon the 
right side than on the left. 

In the intrascapular region the sound on percussion is dull on 
the right side; otherwise everything is normal. 

Cardiac dulness rather increased. 

Auscultation reveals anteriorly in the left supra-clavicular re- 
gion, undoubted sonorous rales in the apex of the lung. On the 
right side, undetermined respiration. Vocal vibration and fremitus 
stronger over the right thorax than over the left. 

Puerile respiratory murmur posteriorly, but much weaker on 
the right side than on the left. 

The patient inhaled, during six weeks, at first common salt alone ; 
later with the addition of the bicarbonate of sodium, both in the 
some proportion, gradually increased to half an ounce to twenty- 
four ounces of water, to which at times a little tincture of opium 
was added. The beneficial effect was not temporary only, it was 
continuous ; and to-day (reported in 1865) the patient still remains 
comparatively well, and pursues his laborious avocation in K . 

Carbonate and Bicarbonate of Sodium. 



Dose. — One to ten or more grains to the ounce of 

iter. 

These remedies are emollient and resolvent, the bicar- 



274 ARTICLES OF THE MATERIA MEDICA 

bonate being the milder of the two. They are indicated 
in acute catarrhal inflammations of the respiratory tract, 
and in the acute exacerbations of chronic inflammatory 
aifections ; and they are often administered to better ad- 
vantage at a warm temperature. They are said by Wal- 
denburg to be of great use in acute tonsillitis, hastening 
suppuration and rupture of the abscess. The same author 
considers their most prominent indication to be in cases 
of parenchymatous or so-called granulous pharyngitis. 

They are also employed with advantage in chronic 
catarrhs with tenacious viscid secretion, including cases 
of chronic and fetid coryza. 

Gerhardt has employed inhalations of bicarbonate of 
sodium in valvular disease of the left side of the heart, 
as well as in recent catarrhs of the air-passages. In 
cardiac affections he employs a solution containing from 
one-half to one and one-half per cent, of the salt. 

Carbonate of Potassium. 

Dose. — One grain to one drachm to the ounce of 
water. 

This remedy is similar in its action to the carbonate 
of sodium, and is employed in the same aifections. It 
is recommended in recent laryngeal and bronchial ca- 
tarrhs, and in follicular pharyngitis. (Siegle, Lewin.) 

It has likewise been employed in pneumonia, whoop- 
ing-cough, and membranous croup. 

Chloride of Ammonium. 

Dose. — One grain to a drachm to the ounce of water. 

This is one of the most useful remedies, and may be 
employed in almost all instances in which it is desirable 
to promote secretion. It has also an alterant and ab- 



SUITABLE FOR NEBULIZ ATION. 275 

sorbent influence upon tumefactions of the glands, sub- 
mucous connective tissue, and the mucous membrane. 

It is used in acute catarrhal inflammations of the 
larynx and bronchi (Siegle, Lewin, Gerhard t, Walden- 
burg), in acute exacerbations of chronic catarrhs (Wal- 
denburg), in chronic catarrhs with difficult expectora- 
tion, in acute and chronic coryza, and in emphysema 
and asthma resulting from chronic bronchitis (Gerhard t, 
Waldenbnrg). It has also been recommended, in com- 
bination with table-salt, in phthisis (Gerhardt), though 
usually considered contraindicated in that disease, even 
merely to promote expectoration, especially when there 
is any disposition to haemorrhage from the lungs. 

Waldenbnrg especially recommends the formula fol- 
lowing, in superficial catarrhal inflammations of the 
pharynx, larynx, trachea, and bronchi : twenty-five parts 
of muriate of ammonia dissolved in one hundred parts 
each of distilled water and glycerin, of which one to two 
tablespoonfuls in a wineglassful of water is used at each 
inhalation. 

I have found the muriate of ammonia a very useful 
remedy in the dry variety of chronic pharyngitis, pha- 
ryngitis sicca ; and in a number of cases occurring in 
shopkeepers, prompt relief has often soon followed its 
employment, three times a day, at the place of business, 
— before opening the store, at noon, and before closing. 
I have seen the like good results in bronchitis sicca also. 

Siegle states* that, in acute catarrhal laryngitis, after 
the severer symptoms have subsided, when the main 
object is to facilitate the expectoration, he has found the 
greatest advantage from a solution of four grains of sal 

* Op. cit., p. 58. 



276 ARTICLES OF THE MATERIA MEDICA 

ammoniac to the ounce of distilled water, several times 
a day, the patient sitting in close proximity to the ap- 
paratus. 

Chlorate of Potassium. 

Dose. — One to fifteen grains to the ounce of hot water. 

Chlorate of potassium is frequently used in spray, for 
all those purposes for which it has long been used in the 
form of a gargle. Thus, in the aphthous conditions of 
the mouth (Siegle, Lewin), in noma, cancrum oris, in 
aphthous processes in the pharynx and larynx (Walden- 
burg), in pharyngitis (Lewin), tonsillitis, in sore throat 
in general, and in ptyalism from mercury. It is also 
recommended in diphtheria by Lewin, who has recorded 
in detail* eighteen cases of diphtheria treated by him, 
in part with inhalations, chiefly of chlorate of potassium ; 
of which number fifteen recovered. 

These cases were pharyngeal diphtheria chiefly, the 
larynx being little or not at all affected ; except in one 
instance, in which it was severely implicated. 

Very few physicians would be willing to place any 
reliance on chlorate of potassium as the chief medication 
in diphtheria. 

Chlorine. 

Solution of Chlorinated Soda. — Dose. — From five min- 
ims to a drachm to the ounce of water. 

Chlorine Water. — Dose. — Five to twenty minims to 
the ounce of water. 

These will be found useful applications in all affec- 
tions of the mouth, nostrils, and air-passages, attended 
with fetor. I have sometimes found chlorine water the 

* Op. cit.,pp. 466-499. 



SUITABLE FOR NEBULIZ ATION. 277 

only effectual corrective in some cases of chronic fetid 
coryza. The solution of chlorinated soda has been 
recommended in bronchitis, with offensive and copious 
secretion, and also in phthisis by Da Costa, who like- 
wise recommends the employment of the diffused spray 
as a disinfectant. In a letter upon this point, from that 
gentleman (1866), he has written me: " Having had a 
good deal of facial erysipelas brought into the wards at 
the Pennsylvania Hospital, and two cases subsequently 
developing themselves there, I used chlorinated soda. In 
a few minutes the whole ward was filled with the odor 
of chlorine, and during the whole dav and evening the 
particles of soda burn flickeringly in the lighter gas 
with their characteristic yellow flame, a good proof of 
diffusion. Surely, to disinfect rooms, etc., there is noth- 
ing better/ 7 

Solutions of chlorine are sometimes used in the treat- 
ment of pulmonary gangrene. 

In relation to this affection, Dr. Beigel states* that when 
he was physician to the spa of Reinerz he remembers 
some individuals who had visited that resort in the hope 
of procuring relief from the fetid odor of their breath ; 
and he relates the case of a young Russian, set. 21, who 
had been subject to phthisis for years, and in both of 
whose lungs there Were signs of large cavities. 

" The breath of this patient was so fetid that he found great dif- 
ficulty in securing apartments. He was made to inhale a solution 
of chloride of lime (one drachm to the ounce), which did not 
cause any cough ; and though its effect was unmistakable, chlorin- 
ated water (one part to six parts of water) was substituted, which 
made the patient's condition much more tolerable. He inhaled 
nearly every hour, and almost from the first inhalation the im- 

* Op. cit., p. 190. 
24 



278 ARTICLES OF THE MATERIA MEDICA 

proveruent was so marked that one could remain with him a quar- 
ter of an hour or more, which before had been impossible." 

Permanganate of Potassium. 

Dose. — One to ten grains to two ounces of water. 

The spray of a solution of permanganate of potassium 
was employed by Reveil to disinfect tainted atmosphere, 
by nebulizing a solution containing a large teaspoonful 
to two and three-quarter pounds of water. He also 
employed from ten to thirty drops of the solution per 
diem in pharyngeal diphtheria. I have found this 
remedy valuable as a detergent and astringent in ulcer- 
ative tonsillitis, and other suppurative affections of the 
throat ; using just sufficient of the salt to tinge the water 
in which it is dissolved. 

It is useful in fetid coryza ; and is indicated in aph- 
tha, diphtheria, putrid bronchitis, and pulmonary gan- 
grene ; and likewise in cases of fetid ulcerations of the 
pharynx and larynx, of whatever origin. I have used 
it locally with good effect in the anginose forms of scar- 
latina, one instance being the most threatening one that 
I ever saw recover. 

Iron. 

Solution of Chloride of Iron. — Dose. — One to thirty 
minims to the ounce of water. 

Sulphate of Iron. — Dose. — Half a grain to ten grains 
to the ounce of water. 

Iron is used both as an astringent and as a styptic; 
but must not be continued for too long a period, as its 
prolonged use is apt to impair the appetite. Its chief 
employment is in severe haemoptysis (Hillairet, Zdek- 
auer, Lingen, Lewin, Waldenburg, Siegle, Wedemann, 



SUITABLE FOR NEBULIZ ATION. 279 

Leiblinger, Fieber, Da Costa, and others). One drop 
of the officinal solution to the ounce of water is often 
sufficient to restrain a moderate haemorrhage; but in 
severe haemorrhages the larger doses are sometimes 
requisite. It is likewise employed as a styptic after 
atnygdalotomy ; and as an astringent in chronic phar- 
yngitis, laryngitis, and bronchitis, with excessive se- 
cretion (Gerhardt, Lewin, Da Costa). My own expe- 
rience with iron in the last-named affections has not 
been at all encouraging:. Iron has been recommended in 
the earlier stages of phthisis (Lewin, Da Costa); but 
according to some (Lewin), it is contraindicated in the 
phthisis of delicate females, accompanied with fever and 
irritability of the mucous membrane. Lewin employed 
it with good result in a case of pharyngo-laryngitis, 
with occasional aphonia ; and it has been recommended 
by Da Costa as a weak inhalation in hysterical aphonia. 

Dr. Wedemann, of Jena, assistant in the clinic of 
Prof. Gerhardt, has reported* a case of whooping-cough 
in a child seven years of age, in whom the intensity of 
the spasms of cough began to diminish after the very 
first inhalation of a solution of the sesqnichloride of 
iron, three drops to the ounce of water. 

Success in its use has furthermore been reported in 
pulmonary gangrene (Gerhardt), and in croup and diph- 
theria (Lewin). 

The solution of the sesquichloride of iron is the rem- 
edy most frequently resorted to in haemoptysis, on ac- 
count of its well-known haemostatic property, coagulat- 
ing the fibrin of the blood into an insoluble clot, and 
thus preventing further escape of the blood. It is also 

* Op. cit , p. 42. 



280 ARTICLES OF THE MATERIA MEDICA 

absorbed by the bronchial mucous membrane, and is 
thus to be used in cases of ansemia, with an ulterior 
view as to its ordinary therapeutic effect. It is to be 
resorted to in threatening cases, but is contraindicated in 
the febrile states of phthisis, and in delicate individuals 
with great sensitiveness and irritability of the mucous 
membrane. Lewin mentions the case* of a lady in whom 
the inhalation of a solution of the sesquichloride of iron 
employed for a profuse bronchorrhcea always induced a 
slight haemoptysis, even when in the proportion of but 
half a drop of the solution of chloride of iron to the 
ounce of water. I have encountered a similar result 
when employing the remedy to restrain haemorrhage. 

In using these ferruginous inhalations, care must be 
taken to protect the teeth. 

Lewin suggests the possibility of the iron exciting a 
plastic exudation in a pulmonary cavity, the same as 
when injected into the sac of a hydrocele, and the like. 

The strength of the solution used for the purpose of 
arresting haemoptysis varies considerably with various 
authorities. From two to five grains to the ounce is 
ample, for a small proportion of iron will coagulate a 
large quantity of blood. Prof. Zdekauer employed a 
drachm to six ounces of water; half of which quantity 
was inhaled at each sitting by means of Mathieu's in- 
strument. And by the way, the instrument of Mathieu, 
if at hand, or the insufflator of Bergson with the double 
bulb, on account of the low temperature of the spray 
they produce, are preferable in these cases to the steam 
apparatus. In cases of great danger, where the patient's 
strength must be economized to the utmost, the propor- 

* Op. cit., p. 348. 



SUITABLE FOR NEBULIZ ATION. 281 

tion of iron in the solution can be increased, in order to 
diminish the time of inhalation. 

It must not be forgotten that many pulmonary haem- 
orrhages cease promptly without the introduction of a 
haemostatic; which fact renders it difficult, in ordinary 
cases, to judge of the exact value of the inhalations. 

That ferruginous inhalations have often saved life by 
promptly arresting haemoptysis, and keeping up contrac- 
tion of the bloodvessels, has been abundantly attested by 
the records of many hundred cases from the pens of 
various observers. 

One or two striking examples are introduced in illus- 
tration : 

Fieber* relates a remarkable case in a man whose whole family 
were predisposed to affections of the respiratory organs, and several 
of whom were suffering from pulmonary and tracheal troubles. 
About fifteen years previous, the patient, at that time twenty years 
old, while journeying in winter, was attacked with haemoptysis 
and pneumonia. Various treatment had been employed for the 
cough, etc., without success. Dr. Wagner became acquainted with 
the patient in 1860. At that time he had an exceedingly severe 
cough, with profuse bloody expectoration. The apices of both 
lungs were infiltrated with tubercles, the right one to a very great 
degree. The sound on percussion was dull, and the respiratory 
murmur almost entirely bronchial. The region under the right 
clavicle became more and more sunken in, slight pains in the 
right thorax and under the right shoulder-blade were complained 
of, and the patient emaciated greatly. Whey, cod-liver oil, and 
mild narcotics with quinine, were of benefit, so that after a while 
the patient felt like travelling and resuming his employments, but 
desisted from so doing on account of his catarrh and slight attacks 
of haemoptysis. In the year 1861, the patient complained of a sense 
of weight in the right loin and the right testicle, which latter organ 
was enlarged, hard, uneven, and painful on pressure. This was 
attributed to strain at stool. All the emollient, soothing remedies, 

* Op. cit., p. 141. 



282 ARTICLES OF THE MATERIA MEDICA 

in connection with rest, etc., produced no effect. The diagnosis 
pointed to tuberculous infiltration. A suspensory had to be worn. 
The patient's appetite was always moderate ; bowels constipated, 
requiring laxatives. He would lose flesh and regain it, and lose it 
again. Continued speaking and physical fatigue were very well 
borne. Earty in December, the bronchial catarrh exacerbated 
and increased to a very great degree. At the same time he became 
subject to attacks of haemoptysis of such vehemence that his life 
was in constant danger. This condition had continued, in spite of 
all remedies, for more than five weeks, when, on the 9th of Janu- 
ary, inquiry was made of Dr. Fieber whether it ivould be possible 
by means of inhalations to keep the patient alive for three or four 
days to see his brother, whose arrival was expected at that time. 
Fieber found the patient in a state of great helplessness, hardly 
able to move himself, and barely able to converse. A thorough 
examination — which would have been superfluous — was impossible. 
All sorts of remedies had been so ineffectual that the patient had 
discarded medicine, and contented himself by sucking enormous 
quantities of small pieces of ice. On the day, on the evening of 
which the inhalatory treatment began, four pints of blood were 
expectorated. With little hope of good result, the inhalation was 
begun that 9th of January, the greatest care being necessary for fear 
of exciting even a moderate.parox3 T sm of cough, which would have 
resulted in a haemorrhage which might have proved fatal. A solu- 
tion of the sesquichloride of iron (which, by the way, had been 
given by the stomach with no better effect than anything else), 
two scruples to two pounds of spring water, was placed in the sec- 
ond model of Charriere's apparatus, and only such pressure exer- 
cised as absolutely necessary to nebulize the fluid. The patient 
was permitted to inhale this so cautiously that a quarter of an 
hour's rest was allowed after every fifth inspiration. Three such 
sets of inspirations were given in the forenoon and the like number 
in the afternoon, so that he took, daily, thirty inspirations. The 
number was subsequently increased to forty-eight, and the propor- 
tion of the iron increased to a drachm. The result was a happy 
one. On the 10th of January, the patient expectorated only one 
pint of blood. The sputa remained bloody until the 14th, and 
after that, they continued free fn/m tinge. The patient was of a 
very irritable temperament, and every irritation induced conges- 
tion to the lungs. This was the reason that later, after any con- 
siderable emotion, the sputa became tinged with blood, though 



SUITABLE FOR NEBULIZ ATION. 283 

this would quickly disappear. On the 1st day of February, a nar- 
cotic solution was substituted for the ferruginous one, in order to 
diminish the catarrhal phenomena. At the end of April, the in- 
halations were discontinued. The strength of the patient, mean- 
while, had so increased that he was subsequently able, in the 
beginning of June, to travel to Roznan, for the purpose of under- 
going the whey-cure; and there Dr. Polansky resumed the inha- 
lations, employing tannin. Dr. Fieber saw the patient again at 
Vienna, in August; he had improved very much in appearance, 
and was about departing for Berlin to rejoin his relatives. 

Zdekauer reported* a remarkable case of arrested 
haemorrhage, in which the presence of iron in the lung 
was demonstrated after death. This case is detailed by 
Lewin,f and is as follows : 

J. B , an invalid soldier, was sick with Bright's disease, with 

albuminuria and consecutive dropsy. Close examination revealed 
the existence, at the same time, of hypertrophy of the heart, and 
either insufficiency of the mitral valve, or atheromatous excres- 
cences in the aorta. The diagnosis was difficult on account of the 
pressing upwards of the diaphragm by ascites ; and the short, but 
rough respiratory murmur was so loud and difficult to restrain, 
that only an occasional systolic murmur could be heard: while 
percussion elicited the existence of an enlargement of the heart. 

Milk, diuretics, nitrate of potassa, and other remedies, were all 
ineffectual. The dropsical exudation and effusion increased rap- 
idly ; the patient could onl} 7 breathe when sitting in an arm-chair. 
One day he was attacked with suffocation, followed by a terrific 
haemorrhage, which seemed to have no disposition to cease. 

The apparatus of Mathieu happened to be at hand, as well as a 
solution of the chloride of iron, so that the resort to inhalation was 
made immediately. The poor patient just about breathed, or rather 
gasped for breath, and in two minutes he had fainted. He was 
soon restored to consciousness by sprinkling cold water upon his 
face, and he was made to inhale the solution for two minutes, when 
the hemorrhage ceased as if cut off short ; but it had exhausted the 
remaining strength of the patient, who died two days after with 
suffocative phenomena. 

* Wien. med. TToch , 1861. f Op. cit., p. 240. 



284 ARTICLES OF THE MATERIA MEDICA 

Autopsy. Bloody serous exudation in the right pleural cavit}', 
floating the lung. In the right lung several insulated blood-clots, 
of very dense consistence, and not bloody when cut into. In the left 
lung, similar blood-clots, but much smaller. The heart hyper- 
trophied and covered with fat. Atheromatous deposit in the ascend- 
ing aorta ; insufficiency of the mitral valve. The left kidney much 
degenerated, the right one less so Serous infiltration everywhere. 

Dr. Holm examined the blood-clots, and found, in all parts of 
the lung-structure, iron in much larger quantities than could be 
attributed to the iron of the blood. 

It is an important fact, that this very haemorrhage, which arose 
from great stagnation of the blood and regurgitation into the ves- 
sels of the lungs, was arrested by the inhalation of a watery spray 
containing chloride of iron, and that the deep penetration of the 
solution into the very bleeding tissue of the lung could be demon- 
strated on the corpse. 

Subsulphate of iron has the same uses as other salts of 
iron, and has been recommended by Da Costa in haem- 
optysis. 

Alum. 

Dose. — One to twenty-four grains to the ounce of 
water or some aromatic infusion. 

The weaker solutions are astringent; the stronger 
ones are styptic. 

Alum is used in inhalation in superficial catarrhal in- 
flammations of the palate, tonsils, pharynx, and upper 
air-passages. These inhalations are not applicable to 
the very early stage of acute inflammation, though 
Waldenburg admits their utility when it is probable 
that the disease can be aborted by their early use ; but 
when the stage of secretion has become established they 
are often of efficient service, especially if renewed every 
few hours. In high states of inflammation better effects 
often follow at a low temperature, though many patients 
prefer that the solution be warmed. If the parts are 



SUITABLE FOR NEBULIZ A TION. 285 

painful, as well as swollen, the "watery extract of opium, 
or the like, can be added to the solution with advantage, 
in the proportion of from one-fourth of a grain to a 
grain to the ounce. A solution of alum, in coarse spray, 
is an admirable substitute for the gargle in inflammatory 
conditions of the palate, tonsils, and pharynx; and with 
the horizontal tubes and Clark's bellows can be most 
accurately applied to the diseased parts. Some patients 
are unable to tolerate alum at all, while with others it 
acts, so to speak, like a charm. 

I have repeatedly verified the experience of Schnitz- 
ler, Waldeman, Fieber, Lewin, and others, as to the 
effect of astringent inhalations in uncomplicated cases of 
superficial inflammation of the pharynx and larynx; 
and, occasionally, the result has been so prompt as to 
stagger credence; and the like of which, certainly, has 
not attended other treatment. A couple of cases from 
my notebook in illustration : 

C. F. H n, a stout, hearty driver of an express wagon, 

contracted an intense laryngitis and pharyngitis from exposure 
incident to his employment. When he was sent to me, April 6th, 
1866, after the disease had existed three or four days, his voice 
was very hoarse, and he complained of great pain in swallowing. 
Laryngoscopy revealed intense congestion of the laryngeal mu- 
cous membrane, including that covering the vocal cords. He in- 
haled a nebulized solution of alum during fifteen minutes with 
great relief, and the following day the pain and dysphagia had 
left him, the voice was almost natural, and the parts had assumed 
their normal appearance. 

Mrs. F n applied to me May 1st, 1866, recommended by 

the express driver, whose case has been mentioned. She had been 
suffering from sore throat for several days. I found infiltration of 
the aryteno-epiglottic folds and of the mucous membrane covering 
the cartilages of Santorini. Inhalations of alum water were ad- 
ministered, and she was directed to take three compound cathartic 
pills at bedtime. The next dav she returned nuu-h the better for 



286 ARTICLES OF THE MATERIA MEDICA 

her purge and her inhalation. The inhalation of alum was re- 
peated in the evening, and the day following she was sufficiently 
well to resume her domestic employments and dispense with pro- 
fessional services. Some years afterwards this patient applied to 
me under similar conditions, and was relieved within twenty-four 
hours by the same treatment ; but two inhalations being again 
administered. 

Siegle reports having employed inhalations of alum 
in many cases of acute catarrhal laryngitis, but not with 
much benefit, unless he dieted the patients and kept 
them abed. Beigel, on the other hand, reports several 
cases cured by inhalations of alum. 

Inhalations of alum are of great service in chronic 
inflammations of the palate, pharynx, larynx, trachea, 
and bronchi, especially in simple catarrhal cases with 
excessive secretion. 

Schnitzler* reports three cases of chronic laryngitis 
treated with alum, rapid and marked improvement 
taking place, as shown by laryngoscopic examinations 
by himself and Dr. Stoerk. Improvement set in at 
once after the inhalation, and continued for from six to 
twenty -four hours. 

Alum is also used in chronic bronchitis. Da Costaf nar- 
rates a severe case cured mainly by inhalations of alum, 
eight grains to the ounce, with the addition of six drops 
of the fluid extract of conium,the alum being gradually 
increased to the proportion of twenty grains to the ounce. 
BeigelJ details a case in which inhalations, night and 
morning, of a solution containing two grains of alum 
and ten minims of laudanum to the ounce of -distilled 
water, proved successful after the failure of many other 
remedies ; and also a case of chronic bronchitis, occur- 

* Wiener Med.-Halle, 1862, No. 48. f Op. cit., p. 34. 

+ Op. cit., p. 121. 



SUITABLE FOR NEBULIZ A TION. 287 

ring after small-pox, which succumbed to inhalations 
three times a day, of alum, one grain to the ounce, with 
the addition of ten minims of laudanum. 

Schnitzler also reports* a case of complete aphonia 
cured by inhalations of alum. For two years the pa- 
tient had been subject to recurrent hoarseness, until, 
some six or eight months before treatment by inhala- 
tion, the voice suddenly left, and the aphonia remained 
constant. The laryngoscope showed marked swelling 
of the yocal cords, and of the mucous membrane of the 
larynx generally. Nothing abnormal was detected in 
the lungs. This physical condition was confirmed by 
Semeleder. Inhalations of a solution of alum were in- 
stituted, and on the second day the voice was louder ; 
and in eight or nine days the patient had recovered a 
pretty good voice, though hoarse, which became clearer 
and louder every day. The gradual diminution of the 
catarrhal swelling of the vocal cords was watched with 
the laryngoscope. 

Sieglef employed inhalation of a strong solution of 
alum for three days, with partial return of the voice, in 
a case of hysterical aphonia, of several years' duration, 
the cure being subsequently rendered permanent by local 
faradization. 

Alum has likewise been employed in whooping-cough. 

SiegleJ reports the cases of two sisters, aged respec- 
tively three and five years, in whom the disease had 
lasted for five days. He employed inhalations of a so- 
lution of alum, a drachm to six ounces of water, twice 
daily, ten minutes at a time. By the night of the very 
first day the paroxysms had abated in violence, and the 

* Loc. cit. f Op. cit., p. 70. % Op. cit , p. 73. 



288 ARTICLES OF THE MATERIA MEDIOA 

cases were completely cured ; the younger on the eighth 
day of treatment, and the other a few days later. 

Alum inhalations have been recommended in chronic 
pulmonary phthisis in all its stages (Waldenburg). 
Waldenburg employs the alum also in combination with 
tar-water. 

It is likewise occasionally used as a styptic in mod- 
erate hsemoptysis (Tobold, Polansky, Schlesinger, Sie- 
gle), especially when occurring in acute inflammatory 
conditions; being indicated in cases in which it is not 
desirable to impress the organism with the influence of 
a remedy which is liable to absorption by the bronchial 
mucous membrane. It likewise seems to produce a 
more prolonged effect than iron. 

Alum has been recommended in dilatation of the 
bronchi with excessive secretion (Niemeyer); in putrid 
bronchorrhoea ; in pulmonary gangrene (Trousseau) ; in 
croup and diphtheria (Lewin) ; in laryngeal excrescences 
(Siegle). etc. I have found it useful in the sore throats 
of the exanthemata, having most experience, however, 
in the sore throat of scarlatina. 

Dr. Semeleder, of Vienna, relates* a case of stenosis 
of the larynx, supervening during the healing of an in- 
cised wound, completely relieved by inhalations of a 
solution of alum. 

A woman, aet. 46, endeavoring to commit suicide, cut her throat 
with a razor, about the position of the upper border of the thyroid 
cartilage. The larynx was opened close under the epiglottis, and 
thence the wound communicated directly with the pharynx. The 
voice was low and difficult, swallowing painful, and on an at- 
tempt to drink, some drops would flow down between the aryte- 
noids upon the vocal cords, and thence out of the wound. 

* Wochenblatt der Zeitschrift der K. K. G-esellsch. d. Aerzte in 
Wien, No. 1, 1864; Lewin, op. cit, p. 289. 



SUITABLE FOR NEBULIZ ATION. 289 

On the fourth day, an elastic catheter, and over this a double 
canula of hard rubber, was placed within the glottis through the 
wound, with relief to respiration and expectoration. After the 
condition of the patient had gradually improved to a remarkable 
degree, suddenly, on the forty-ninth day, she was seized with dif- 
ficulty of breathing, following exposure to cold, accompanied 
with swelling of the vocal cords, true and false, and the produc- 
tion of a stenosis of the larynx. To relieve this, the inhalation 
of a nebulized solution of alum in water was employed, beginning 
with a drachm to a pound of water, and later increased to two 
drachms with the addition of a few drops of laudanum, in order 
to retain the astringent effect of the inhalations. 

The patient inhaled, once daily, six to eight minutes, the canula 
being closed. She improved so much that the swelling and con- 
gestion of the whole laryngeal structures, as well as the epiglottis, 
gradually became reduced. Immediately after each inhalation 
the voice was much louder than it had been before. After three 
weeks of these inhalations, the glottis had again become so mov- 
able that the canula was withdrawn from the wound. The pa- 
tient breathed freely without the canula, and the voice gradually 
improved. 

Few practitioners would like to trust a case of laryn- 
geal stenosis, acute or chronic, to the remedial agency of 
sprays. 

Tannic Acid. 

Dose. — One to sixteen grains to the ounce of water. 
Astringent in weak solution ; styptic in strong solution. 

Tannin is very extensively used by inhalation, usually 
fulfilling indications similar to those of alum. It ap- 
pears to be rather better adapted than alum to affections 
of some continuance. It is used as an antiseptic as well 
as a styptic and astringent. It is apt to produce a good 
deal of dryness in the throat and sensations of heat, on 
whicli account it is usually best to begin with small 
doses. 

It has been recommended in chronic catarrhal inflam- 
mations of the palate, pharynx, larynx, trachea, and 



290 ARTICLES OF THE MATERIA MEDICA 

bronchi; in torpid cases of hypersecretion; in bronch- 
orrhoea (Siegle), especially on account of its antiseptic 
action; in haemoptysis (Polansky, Fieber); in pulmonary 
gangrene (Trousseau); in croup and diphtheria (Trous- 
seau, Barthez, Lewin, Fieber); in oedema of the larynx 
(Trousseau); in polypoid excrescenes (Klimbacher); and 
in spasmodic coughs. 

In ordinary chronic sore throat, or catarrhal inflam- 
mation of the palate, pharynx, and posterior upper por- 
tion of the larynx, an affection of great frequence, and 
particularly suited to treatment by sprays, I have seen 
good effects from inhalations of tannin, one grain or 
more \o the ounce, repeated once, or at most twice, a 
day. It is better to prepare the solution as it is required 
(to avoid change into gallic acid), and to filter the solu- 
tion before using it. In my own practice, tannin has 
yielded better results than alum, though this is by no 
means a general observation. The remedy comes into 
play, too, after amygdalotomy. 

Demarquay found great benefit in a dozen of cases of 
granular pharyngitis from the inhalation of tannin, one 
part to one hundred parts of water, with the use of the 
waters of Eaux-Bonnes, where the treatment was insti- 
tuted . 

In general, the condition of the patients improved 
under the influence of three to four nebulizations a day. 
Sometimes improvement began in a single day. In from 
twenty to twenty-five days, he cured a young lawyer, 
whose voice lost its power on moderate exercise, of a 
dryness of the throat, with slight but long-continued 
cough and bloody sputa. Examination of the pharynx 
showed a chronic inflammation of the entire region, with 



SUITABLE FOR NEBULIZ ATION. 291 

a normal development of the pharyngeal glands. Trous- 
seau witnessed this case. 

Demarquay, however, does not consider this treatment 
a radical cure for granular pharyngitis, the cause of 
which he considers to exist deeper in the organism. 

I have little faith in the use of sprays in this variety 
of pharyngitis. 

Dr. Johann Schnitzler* reported a case of pharyngo- 
laryngitis in an individual about thirty years of age. 
Marked improvement ensued in a few days from inhala- 
tions of tannin, five grains to the ounce of water. This 
was not considered a curable case, inasmuch as the pa- 
tient would not give up the abuse of spirituous drinks, 
to which his catarrh was partly attributable. f 

The same author reports some successful cases of 
chronic laryngitis treated in the same manner. 

Demarquay reported great improvement from an inha- 
lation of tannin, one part to one hundred parts of water, 
in a case of laryngeal phthisis, in which deglutition was 
very painful and almost impossible. 

Tannin has been used by inhalation in croup and 
diphtheria. BarthezJ details four cases of croup, treated 
by him at the Hopital des Enfants, St. Eugenie, with 
inhalations of tannin, five to ten parts to one hundred 
parts of water, from eight to twenty times a day, fifteen 
to twenty minutes at a time. In these cases the effect of 
the remedy upon the membranous exudation was excel- 
lent. Respiration became freer, the dyspnoea dimin- 
ished, and the suffocative paroxysms subsided. Two 

* Wiener Medicinal-Halle, 1862, No. 48, p. 442. 
f Lewin, op. cit., p. 259. 

X Traitement des angines diphtheritiques par la pulverization, 
Paris, 1861. 



292 ARTICLES OF THE MATERIA MEDICA 

of the cases terminated fatally, in consequence of the 
systemic poisoning, for in one of the cases where the 
presence of the membrane had been diagnosed, no trace 
of it could be found upon post-mortem examination. 

The first case, a girl, aet. 4J, was one of general diphtheritis, with 
pseudo-membranous exudation in the nostrils, upon the lips, in the 
mouth, larynx, and doubtless in the bronchi Death occurred on 
the sixth day after commencing treatment, and the twelfth of the 
disease. At the autopsy there was no relic of pseudo-membrane 
anywhere on the tonsils, pharynx, larynx, trachea, or bronchi. 

This case showed us, remarks Barthez: 

1st. A modification of the local appearances after twenty-four 
hours, under the influence of the nebulized solution of tannin. 

2d. The local improvement the greater, the more the pseudo- 
membrane came in contact with the nebula. 

3d. The corresponding diminution of the general symptoms of 
diphtheritic intoxication, with the diminution of the local symp- 
toms. 

The second case, a boy, a?t. 5£, was diphtheritis of the pharynx, 
larynx, and nostrils. Internal treatment with large doses of ses- 
quichloride of iron, and inhalations of a tannin solution ; imme- 
diate and permanent benefit by the inhalation of tannin ; improve- 
ment in the croupal symptoms while the systemic poisoning rapidly 
increased, and the child died on the twelfth day of the disease, and 
tenth of the treatment. 

The third case, a boy, set. 3, was one of angina membranacea — 
croup in the second stage. Treatment by inhalation began on the 
fourth day, with repeated inhalations of a nebulized solution of 
tannin. For three days the disease remained stationary; then 
improvement rapidly ensued, with recovery on the ninth day. 

The fourth case, a girl, aet. 3£, was one of croup in the first stage, 
with pseudo-membranous exudation upon the tonsils, the soft 
palate, and the uvula. Prompt recovery on the fourth day of 
treatment by inhalation of a solution of tannin. 

Fieber,* who, having translated Barthez's cases, treated 
fifteen cases of his own in the same manner, reports two- 

* Op. cit., p. 114; Wiener Medic -Halle, 1862, Nos. 17, 20, 24. 



SUITABLE FOR NEBULIZ ATION. 293 

thirds of them cured, the remaining third having ter- 
minated fatally. He combats Barthez's opinion as to 
the mechanical effect of the tannin, which, according to 
that observer, is to pucker the membrane, so that its 
edges roll over, and thus eifect its gradual detach- 
ment ; and states that he has never seen this effect, but 
that the membrane appears to him to become, as it were, 
dissolved under the influence of the tannin. 

Da Costa,* in commenting upon these cases, remarks 
that when we look at the length of the treatment, it does 
not look as if the remedy had any marked solvent power, 
for diphtheritic membranes are not permanent struc- 
tures, but are very apt to disappear from the circumfer- 
ence to the centre within a week after their appearance ; 
and hence, if we accord any value to the treatment — 
which, bearing in mind the usually fatal character of 
laryngeal diphtheria and the grave character of pseudo- 
membranous croup, we cannot totally refuse to do — we 
must also admit that the action is not rapid, and not 
what we might expect from a solvent; nor can we over- 
look the effect of the water in the combination as a 
cleansing agent, and as tending to aid in removing and 
in expectorating the breaking-down textures, for in 
Siegle's hands the inhalation of pulverized warm water, 
alone, produced the greatest relief in an apparently hope- 
less case. 

Trousseauf records a severe case of oedema of the 
larynx promptly relieved by inhalations of tannin. 

A woman, set. 21, who had recovered from puerperal peritonitis 
six weeks previously, was admitted into the hospital with great 



* Essay on Inhalations, Now York, 1867, p. 30. 
f Clinique medieale de 1 'Hotel Dieu, Paris, 1861, p. 475. 
25 



294 ARTICLES OF THE MATERIA MEDICA 

pain in the throat, swollen tonsils, and difficulty in swallowing. 
The angina, already of ten days' duration, increased rapidly in 
severity, at times impeding respiration to such an extent as to 
threaten life. Inspiration was accompanied by laryngotracheal 
rales, although respiration was free, and the voice retained its nat- 
ural tone. The countenance of the patient was like that of one 
threatened with asphyxia; the pulse extremely small; the sub- 
maxillary region tumid and painful. The pharyngeal mucous mem- 
brane was very much inflamed, and examination with the finger 
revealed an (edematous swelling of the epiglottis and the aryteno- 
epiglottic folds. The diagnosis was, of course, oedema of the 
glottis. 

Inhalations of a strong solution of tannin from the apparatus of 
Mathieu were at once instituted, and repeated hourly ; under the 
influence of which the attack moderated, and on the following day 
there was marked improvement, — but a single suffocative paroxysm 
ensuing, and that of less intensity, — with greater freedom of respi- 
ration, and disappearance of the rales. The swelling of the epi- 
glottis and of the aryteno-epiglottic folds had markedly diminished 
likewise. The respiration soon became normal, and only a single 
suffocative paroxysm occurred in twenty-four hours ; and in four 
days the patient left the hospital advanced in convalescence. 

Trousseau also reported to the Academy of Medicine 
another case of oedema of the larynx likewise cured by 
inhalations of a solution of tannin. 

In aphonia from paralysis of the vocal cords, now 
usually treated by the local application of the electric 
current, Dr. Klimbacher* employed with success, in ad- 
dition, inhalations of a solution of tannin. 

In one case of aphonia from the inhalation of hot 
smoke and flame during exposure in a house on fire, I 
employed inhalations of tannin for the laryngeal trouble, 
after the more acute symptoms of laryngitis had sub- 
sided, and during their employment the patient recov- 
ered her voice. 

* Fiaber, op. cit., p. 119. 



SUITABLE FOR NEBU LIZ ATION. 295 

In several other cases contracted under the same cir- 
cumstances, which, under my own observation, were 
treated by Dr. W. W. Keen, of this city, the same re- 
sult followed the same treatment. In these cases, how- 
ever, the relief of the local trouble causing the loss of 
voice in the first instance, naturally relieved the aphonia. 

I have in this way incidentally relieved several apho- 
nias dependent on laryngitis, bronchitis, and the like. 

Nebulized solutions of tannin have been used in 
whooping-cough, by Steffen and others.* 

Tannin is a favorite local remedy in the ordinary 
form of chronic bronchitis. Wedemann highly recom- 
mends a solution two grains to the ounce, with the addi- 
tion of one-twentieth of a grain of morphia. 

Beigelf details a severe case of chronic bronchitis 
which he relieved by inhalations, night and morning, of 
three grains of tannin with two grains of the extract of 
hyoscyamus to the ounce of distilled water ; though he 
subsequently changed the treatment, on account of the 
taste of the remedy, to sulphate of iron, four grains to 
the ounce. 

Trousseau speaks of the value of tannin, among other 
remedies, in pulmonary gangrene, j 

Ruhle observed favorable results from the antiseptic 
influence of inhalations of tannin in the catarrhal inflam- 
mations accompanying typhus fever.§ 

Inhalations of tannin are sometimes employed to re- 
strain haemorrhage in haemoptysis, inasmuch as, like 
other styptics, it also coagulates the blood, is an astrin- 
gent, and diminishes secretion. It is said to be less apt 

* Schmidt's Jahrb., July, 1866, p. 62. f Op. cit., 124. 
j Clinique medicale, Paris, 1861, p. 583. 
\ Baumgartner, op. cit., p. 91. 



296 ARTICLES OF THE MATERIA MEDICA 

to excite inflammation than iron, and its influence is 
probably more continuous. It is indicated in the milder 
cases of haemoptysis, the so-called passive haemorrhages, 
and when inflammation is present; also in cases where 
it may not be desirable to introduce iron into the blood ; 
in the bloody sputa of bronchorrhoea, where it comes in 
play as an antiseptic. It can be administered in larger 
doses than the iron, — say from ten to twenty grains to 
the ounce. 

Extract of Rhatany. 

Dose. — One to ten grains to the ounce of water. 

This astringent is sometimes employed instead of tan- 
nin. It was used by Bataille in chronic inflammations 
of the mucous membranes of the air-passages, and he 
reports having derived great benefit from it in his own 
case. It has been recommended by Trousseau in pul- 
monary gangrene. 

Ergot. 

Fluid Extract of Ergot. — Dose. — One to ten minims to 
the ounce of water. 

Ergot is sometimes employed as a haemostatic, in haem- 
optysis, instead of iron, tannin, or the like. 

Sulphate of Zinc. 

Dose. — Half a grain to ten grains to the ounce of 
water. 

This remedy is used by inhalation for its astringent 
properties. It admirably supersedes the gargle in 
chronic inflammations ; and has been recommended in 
cases attended with excessive secretion. (Siegle, Fieber, 
Lieblinger, Turck, Lewin.) 

It is often of use in chronic coryza; but, to be of ser- 



SUITABLE FOR NEBULIZ ATION. 297 

vice, the parts must first be cleansed of accumulated secre- 
tion by the douche and syringe. In obstinate cases of 
simple chronic sore throat, with infiltration and thicken- 
ing of the mucous membrane, I have seen very satis- 
factory results from morning and evening inhalations of 
a weak solution of sulphate of zinc, a grain or two, to 
two, three, or four ounces of water. 

Fieber reports prompt success in acute catarrhal lar- 
yngitis, from inhalations of sulphate of zinc with the 
addition of laudanum. The same author also reports* 
a case of laryngotracheal catarrh, with almost complete 
aphonia, in which the voice soon returned under the 
inhalation of a solution containing six drops of laud- 
anum and six grains of sulphate of zinc to the ounce of 
water. 

Fieber likewise speaks highly of sulphate of zinc in 
putrid bronchorrhcea. He also reports a case of chronic 
bronchitis simulating consumption, of twenty-five years' 
standing, which improved to a marked degree under the 
inhalation of a solution of sulphate of zinc, five grains 
to the ounce. This remedy has furthermore been rec- 
ommended in emphysema and in haemoptysis. 

Sulphate of Copper. 

Dose. — One to twenty grains to the ounce of water. 

This salt has likewise been used for astringent pur- 
poses in chronic coryza, in tonsillitis, in pharyngitis 
and laryngitis (Vogler), in ulcerative tonsillitis, in ul- 
ceration of the palate and pharynx, in ulcerative laryn- 
gitis (Da Costa), and in pulmonary gangrene (Trous- 
seau). 

* Op. cit., p. 119. 



298 articles op the materia medica 

Acetate of Lead. 

Dose. — One to ten grains to the ounce of water. 

This remedy is employed as an astringent. It has 
been recommended in obstinate, troublesome colds, not 
yielding to other medicament (Beigel) ; in acute catarrhs 
of the larynx and bronchi (Fieber), and in pulmonary 
phthisis, especially in the stage of softening of the case- 
ous deposit, with disposition to diarrhoea (Waldcnburg). 

Chloride of Zinc. 

Dose. — One-tenth of a grain to two grains to the 
ounce of water. 

This remedy is occasionally employed as an astringent 
in obstinate inflammations of the pharynx and larynx, 
not yielding to ordinary remedies. It is a useful deter- 
gent in cancerous inflammations of these structures. 

Nitrate op Silver. 

Dose. — One-sixth of a grain to ten grains to the ounce 
of water. 

Nitrate of silver, used as astringent, alterant, and 
styptic, has been extensively employed in chronic in- 
flammations of the pharynx and palate, and of the upper 
part of the larynx; and, to a less extent, in analogous 
affections of the larynx, trachea, and bronchi. It is 
especially applicable to cases in which there are erosions 
or superficial ulcerations ; but it must not be adminis- 
tered in the stronger solutions without great circumspec- 
tion, in the presence of a competent attendant; nor at 
all, according to my own observations, until it is evident 
that all milder remedies are insufficient. Inhalations of 
a weak solution of nitrate of silver have been employed 






SUITABLE FOR NEBULIZ ATION. 299 

with success in cases of obstinate chronic pharyngitis, 
including even the dry or non-secreting form. I have 
had no experience with this agent in spray in the treat- 
ment of this affection, except when an accompaniment 
of the chronic laryngitis of phthisis. It has also been 
recommended in acute inflammations, but I have had 
little experience of this kind. 

I remember a case of unilateral inflammation of the palate, in- 
volving the submucous connective tissue of the anterior portion, 
and which, though apparently simple in its character, had, by pro- 
longed suffering, pain, and difficulty in swallowing, and the like, 
reduced the patient very much. In this instance I propelled a 
spray of nitrate of silver, twenty grains to the ounce, on the parts 
from a Bergson's apparatus, for a few minutes daily ; and in ten 
days the parts began to heal rapidly, the general health improved? 
and the emaciated patient soon regained her customary robust 
appearance. 

Nitrate of silver has been recommended in granular 
pharyngitis (Lewin, Waldemann, Siegle). It is also 
much employed in chronic laryngitis, for which Lewin 
has recommended the inhalation of a nebulized solution 
of nitrate of silver, one to two grains to the ounce of 
distilled water. I have occasionally essayed this treat- 
ment, but its efficacy has not compared with that of local 
medication, by the sponge, with a strong solution of the 
salt. In fact, I have found astringents proper, more 
useful than nitrate of silver in chronic inflammations, 
unless there be extensive ulceration, under which cir- 
cumstance the nitrate of silver is often preferable. It 
must be confessed, however, that I rarely employ nitrate 
of silver in inhalation, preferring its direct application 
by brush or sponge to all accessible ulcerations. In the 
chronic laryngitis of phthisis, I have sometimes seen 
temporary relief follow inhalations of a weak solution of 



300 ARTICLES OF THE MATERIA MEDICA 

a grain or less to the ounce, with repetition of the effects 
for a long time, even without any marked improvement 
in the local appearances; the remedy seeming to arrest, 
for a while, the progress of destruction in the larynx, 
though incompetent to excite recuperative action. It is 
doubtful if nitrate of silver is ever curative in this af- 
fection. Niemeyer and many others speak favorably of 
these inhalations in chronic catarrhal inflammations of 
the pharynx and larynx. They are also highly extolled 
in chronic bronchitis, and even in pulmonary phthisis. 
(Gerhardt.) 

Dr. Ludwig Joseph,* of Breslau, reports that he has 
employed inhalations of nebulized fluids in chronic affec- 
tions of the larynx, bronchi, and lungs, the medicament 
principally used being solutions of nitrate of silver of 
various strengths. With Tobold, he has experienced 
more benefit from them in affections of the bronchi and 
of the lungs, than in affections of the larynx, where 
topical treatment can be better carried out, and with 
more success. The effect of the nebulized fluids in laryn- 
geal complaints is too weak, and not sufficiently ener- 
getic. Their mild influence is more applicable to affec- 
tions of the bronchial tubes, and of the air-cells, where 
powerful effects are not required. 

In chronic bronchial catarrh, with profuse secretion 
from the bronchial mucous membrane, and in bronchi- 
ectasie, he found the inhalation of nitrate of silver of 
incontestable value. He found it lessen the abnormal 
secretion from the mucous membrane, stimulate the 
membrane by its slight irritation, and thus gradually 
assist the resumption of its normal functions. It seemed 

* Deutsche Klinik, May 26th, 1866. 



SUITABLE FOR NEBULIZ ATION. 301 

also to tone up the bronchial mucous membrane. The 
effect was not equal in all constitutions, but best in slow, 
sleepy, torpid, scrofulous individuals. It was well 
borne in well-founded cases of suspected tuberculosis. 
Dr. Joseph has treated several cases of frank tubercu- 
losis, demonstrable by physical exploration, in this man- 
ner, with the result of diminishing the amount of ulcer- 
ative processes, and promoting general improvement. 
In these cases the general condition of the patients was 
favorable. 

Among others, the following case of chronic bron- 
chial catarrh, with suspicion of tubercle, is of great 
interest : 

P K , of Bremen, vet. 29, a merchant, small in build, 

of delicate frame, well nurtured, came under treatment Sep- 
tember, 1864, having failed to obtain relief from his disease 
from various remedies that had been judiciously employed. He 
was made to inhale a solution of nitrate of silver, five grains to 
the ounce of water; and within three weeks the expectoration 
ceased entirely, and at the date of writing, twenty months there- 
after, there was not a trace of cough or of expectoration. 

Dr. Joseph has never seen any direct injury from the 
inhalations of these solutions of nitrate of silver. At 
the first sittings the patient feels an irritation along the 
course of the trachea, continued sometimes as far as the 
xiphoid process of the sternum, — a feeling of rawness. 
Immediately after the inhalation a quantity of thick 
tenacious secretion is often expectorated with ease. 

He reports a case of bronchiectasia (dilatation of the 
minuter bronchi), in which the most remarkable im- 
provement followed the inhalation, for six weeks, of 
solutions of nitrate of silver, gradually increased in 
strength to a scruple of the salt to the ounce of distilled 
water. 

26 



302 ARTICLES OF THE MATERIA MEDICA 

Dr. Rohn,* of Hanau, was led to the employment of 
inhalations of a solution of nitrate of silver in whooping- 
cough, in consequence of the results of several laryngo- 
scopy examinations of adults and larger children, while 
suffering with this affection. He found the mucous 
membrane covering the anterior wall of the lower por- 
tion of the laryngeal cavity and the commencement of 
the trachea, hypersemic in a marked degree, the vocal 
cords sparkling white and in marked contrast to the 
intense red of the subglottic region. He therefore con- 
siders that the lower laryngeal surface, and the commence- 
ment of the trachea and the upper portion of the trachea, 
are the seat of catarrhal inflammation during the spas- 
modic stage of whooping-cough ; and he is confirmed in 
this view by the uniform statements of adults and larger 
children, that a peculiar severe irritation about the upper 
part of the windpipe precedes the spasm of cough which 
it excites. Dr. Rolm inquires whether the existence of 
the catarrh at this point is not the true cause of the pecu- 
liar paroxysms of cough ; and whether the irritation of 
the inferior laryngeal nerve, which is composed of sensory 
fibres, will produce the same result with irritation of the 
internal filaments of the superior laryngeal nerve. Con- 
cluding, therefore, that the commencement of the spas- 
modic affection might also be due to a catarrhal condi- 
tion of the mucous membrane of the central and smaller 
bronchi, he resorted to the therapeutic effect of inhala- 
tions, in order to reduce the inflammatory process by a 
local caustic action. He has convinced himself that such 
treatment resulted favorably in the cases of six children 
over four years of age, and in two grown persons. The 

* Wien. med. Wochenschrift, xvi, 52, 53, 1866. 



SUITABLE FOR NEBULIZ ATION. 303 

medicament was a solution of the nitrate of silver, from 
half a grain to a grain to the ounce of distilled water, 
according to the age of the patient, and the severity of 
the affection. About half an ounce of the solution was 
inhaled once daily. All these cases were of from three 
to five weeks' duration, and either in the beginning of 
the -convulsive stage, or at its maximum. Dr. Rohn 
stated that after the first two, and at the furthest, after 
the first three inhalations, the cough became markedly 
diminished in violence and duration, and in all of them 
with an immediate abatement of the vomiting; that 
after the fourth and sixth inhalation, the general char- 
acteristic whooping-cough symptoms disappeared ; leav- 
ing behind, at the most, but a slight simple catarrh. A 
still further experience convinces the investigator that 
at least with children over four years of age, who can be 
very well made to take the inhalations, other febrile 
complications of the respiratory organs do not contra- 
indicate the inhalatory treatment.* 

In administering inhalations of nitrate of silver, care 
must be taken that deep inspirations are avoided when 
the remedy is being employed for affections of the phar- 
ynx and upper air-passages, so that the remedy be not 
drawn too deeply into the respiratory tract. The mouth 
speculum, a face protector, or a mask should be used to 
prevent discoloration of the face. Walclenburg recom- 
mendsf smearing the surface around the mouth, before 
inhalation, with any ointment composed of any indiffer- 
ent grease (such as butter, lard, cold cream, and the like), 
and table salt, 

* Schmidt's Jahrbucher, Nov. 1866, p. 57. f Op. cit., p. 243. 



304 articles of the materia medica 

Nitrate of Aluminium. 

Dose. — One to five grains to the ounce of water. 

This remedy is applicable to the same affections as 
nitrate of silver. It was introduced into practice by 
Beigel, who prepared it from a simple solution of alu- 
minium in nitric acid, agitating the crystals repeatedly 
in distilled water, condensing the solution by evapora- 
tion, and recrystallizing. 

Beigel reports great service from its use, not only in 
inflammatory affections, but also in nervous affections of 
the larynx and trachea. 

Corrosive Chloride of Mercury. 

Dose. — One-twelfth of a grain to two grains to the 
ounce of water. (Siegle.) 

Inhalations of the bichloride of mercury are employed 
chiefly in syphilitic affections of the pharynx and larynx 
(Demarquay, Schnitzler,Waldenburg, Lewin, Siegle,etc), 
and they are even said to be effectual in obstinate cases 
which resist the internal or hypodermic administration 
of the same remedy. They have likewise been employed 
in cases of syphilitic excrescences. (Siegle.) Besides its 
specific action, this remedy has an astringent and ab- 
sorbent effect which can often be utilized in non-specific 
affections. In certain chronic, often ulcerative inflam- 
matory (so-called scrofulous) affections of the pharynx 
and larynx, which resemble syphilis, and which, if not 
really syphilitic, certainly yield to anti-syphilitic treat- 
ment, inhalations of the spray of corrosive sublimate 
will frequently be found of the greatest service. 

Syphilitic sore throat has been treated with good re- 
sults by Briau, Demarquay, Schnitzler, Waldenburg, 






SUITABLE FOR NEBDLIZ ATION. 305 

Lewin, and others by inhalations of corrosive sublimate 
one or two grains to the ounce of water. According to 
my own experience, the internal administration of anti- 
syphilitic remedies is much more prompt in its good 
effects. Soothing inhalations afford relief and keep the 
parts cleansed just as in non-specific sore throat. Some 
of the authors named, however, attribute a local specific 
action to the mercurial, and report its successful employ- 
ment topically, after failure by internal administra- 
tion. 

Dr. Johann Schnitzler* reports two cases of syphilitic 
ulcerations of the naso-pharyngeal space, and of the 
larynx, very quickly cured by inhalations of a solution 
of corrosive sublimate, a grain to the ounce. The cleans- 
ing of the ulcerated surfaces could be demonstrated with 
the laryngoscope after each inhalation. 

Demarquayf found rapid improvement in syphilitic 
affections of the soft palate, the pharynx, and the larynx, 
under the influence of nebulized solutions of corrosive 
sublimate, 25 centigrammes to 500 grammes of water, 
which he found the best of all topical remedies, in con- 
nection with internal treatment. The inhalations were 
taken three to four times, and each time from five to six 
minutes in duration. 

In several cases he saw very circumscribed mucous 
patches of these parts disappear rapidly. He remarked 
this particularly in an old man who suffered with great 
hoarseness, and on whose palatum molle there were such 
mucous patches. A general treatment previously insti- 
tuted had afforded no relief, but the patient improved 
promptly under the new method. 

* Op. cit. f Op. cit , Lewin, p. 223. 



306 ARTICLES OF THE MATERIA MEDICA 

Trousseau* mentions the value of inhalations of cor- 
rosive sublimate in pulmonary gangrene. 

Inhalations of the bichloride of mercury should be 
managed with great circumspection, and care be taken 
that the inspirations are not too deep. 

The biniodide of mercury is sometimes used in syphi- 
litic and quasi-syphilitic affections of the larynx and 
pharynx. Waldenburg recommends it in so-called her- 
petic pharyngitis, as an astringent, in doses of from one- 
tenth of a grain, to a grain, to the ounce of water, with 
five times its weight of iodide of potassium. 

Arsenic. 

Solution of Arsenite of Potassium. — Dose. — One to ten 
drops in one or two ounces of water. 

Arsenic has been employed by inhalation in spray in 
nervous asthma (Trousseau, Wistinghausen, Lewin), in 
emphysema, in pulmonary gangrene (Trousseau), and in 
chronic bronchitis; the preparation chosen being usually 
the well-known Fowler's solution. 

It has also been occasionally employed in tuberculous 
phthisis, and has been recommended in cardiac neural- 
gia. (Anstie.) 

Wistinghausenf reports the following case of emphy- 
sema and asthma cured by inhalations of Fowler's solu- 
tion of arsenic : 

A young girl, set. 15, whose mother had died of tuberculosis, had 
suffered from childhood with laryngeal and bronchial catarrh, 
eventuating in emphysema of both lungs with asthmatic paroxysms. 

* Clinique medicale, Paris, 1861, p. 583. 

f Petersburger med. Zeitschrift, 1862, xvii, p. 137, quoted by 
Lewin, op. cit., p. 242. 



SUITABLE FOR NEBULIZATION. 307 

After the employment of a great variety of remedies, external and 
internal; after a residence t during three summers at Wielbach, 
Ems, and Salzbrunn ; and the resort to local gymnastics during two 
winters — all without beneficial result — she was, at the suggestion 
of Prof. Eck, placed under the treatment by inhalation of Fowler's 
solution of arsenic, ten, fifteen, or twenty drops to the ounce of 
distilled water, once or twice a day. The same remedy had been 
administered inwardly without advantage, as had also one-twen- 
tieth to one-fourth of a grain of nitrate of silver, four times a day. 
After ten days of inhalation (ten minutes each day) the asthma 
ceased entirely, and, the inhalations being continued, did not re- 
turn during the severe and cold winter and the variable spring of 
1861. The patient could expose herself in all weathers without 
using the respirator, with which until then she had been unable to 
dispense, even during a short promenade. She could also join in the 
dance until late at night without any trace of shortness of breath, 
though before this treatment the very excitement of receiving an 
invitation to a company would bring on a severe attack of asthma. 
The auscultatory phenomena had not altered much, the mucous 
sibilant rales having subsided only in the right scapulary region. 

The patient had inhaled in all four ounces of the Fowler's solu- 
tion, without any symptoms of arsenical poisoning. After this, 
she inhaled tannin, ten grains to the ounce, and after a time, ex- 
tract of pine (Turion) in the same proportion, thirty drops at each 
time. Sales-Girons's apparatus was employed. Mathieu's instru- 
ment was employed once, but was uncomfortably cold, 

Lewin, also, recommends the use of Fowler's solution 
of arsenic, from half a scruple to half a drachm to twelve 
ounces of water. He relates* several cases in detail 
which he subjected to this treatment with benefit. Some- 
times he added some common salt to the solution. He 
also, and occasionally with benefit, used the oleo-balsamic 
mixture, a drachm to half an ounce of castor water. 

Iodine. 

Tincture of Iodine. — Dose. — One to twenty drops to 
the ounce of water. 

* Op. cit., 442-446. 



308 ARTICLES OP THE MATERIA MEDICA 

Iodide of Potassium. — Dose. — One to ten grains to 
the ounce of water. 

Compound Solution of Iodine. — Dose. — One to thirty 
drops to the ounce of water. 

Compound Tincture of Iodine. — Dose. — One to thirty 
drops to the ounce of water. 

These preparations are employed in chronic inflam- 
matory affections of the pharynx and air-passages, 
whether simple, catarrhal, scrofulous, or syphilitic. They 
are chiefly applicable to affections implicating the glan- 
dular structures, so-called granular and follicular sore 
throats (Siegle) ; also in cases of induration and thicken- 
ing of the mucous membrane itself (Lewin), and in in- 
filtration of the submucous connective tissue. They 
are also useful in the chronic laryngitis of phthisis, and 
have been employed with advantage in chronic bron- 
chitis with emphysema, and in pulmonary phthisis. 

In persistent forms of ordinary chronic pharyngitis, 
which have resisted treatment with astringents, I have 
frequently employed a solution of iodine, a few drops 
of the compound solution to the ounce of water, with 
advantage. 

In the chronic laryngitis of phthisis, both follicular 
and ulcerative, I have frequently derived great benefit 
from inhalations of the compound solution or compound 
tincture of iodine, a few drops to the ounce, with the 
addition of one or two drops of the concentrated solution 
of carbolic acid, or one or two grains of the crystals., 
The same remark applies to analogous affections in 
scrofulous subjects. 

I have likewise seen a good deal of benefit occasion- 
ally from inhalations of a weak solution of iodine, with 
and without the combination of iodide of potassium, in 



SUITABLE FOR NEBULIZ ATION. 309 

emphysema from chronic bronchitis ; and likewise in 
uncomplicated chronic bronchitis. 

Da Costa recommends the compound solution of 
iodine in chronic bronchitis ; and Waldenburg in syphil- 
itic laryngitis. 

If pain be complained of, sedatives or narcotics, such 
as opium and conium, may be appropriately added to the 
solution ; but preferably in minute quantities. 

Bromine. 

Bromide of Potassium. — Dose. — One to ten grains to 
the ounce of water. 

Bromide of potassium acts as a sedative and as a re- 
solvent. It is indicated in cases of irritation and pain ; 
and although it does not produce the local anaesthetic 
effect at one time entertained, it certainly often dimin- 
ishes hypersensitiveness of the mucous membrane. It 
has thus been employed in spasmodic coughs of various 
kinds, especially the so-called hysterical coughs, in re- 
lieving which its sedative influence on the nervous 
system is perhaps co-operative. It has likewise been 
recommended in whooping-cough, by Gerhard and others. 

Dr. J. Winthrop Spooner* recommends the plan 
adopted by Dr. John J. Caldwell, of Baltimore,! to in- 
hale at first twice daily and then once daily, a table- 
spoonful of a mixture made as follows, diluted with an 
equal quantity of water : 1^. Extract of belladonna, 
five to ten minims ; bromide of potassium, one scruple ; 
bromide of ammonium, two scruples ; water, one ounce. 
The good effect is said to be shown immediately ; the 

* Boston Med. and Surg. Jour., Nov. 5th, 1874. 
f Ibid. April 20th, 1871. 



310 ARTICLES OF THE MATERIA MEDICA 

distressing symptoms being promptly relieved, and the 
period of the disease much lessened in its course. 

Inhalations of a solution of bromine have been rec- 
ommended in croup. I have witnessed good results 
from a solution containing one grain of bromine and 
five grains or more of bromide of potassium to the 
ounce of water. 

Dr. Johann Schnitzler* reports two cases of croup, 
treated with inhalations of a solution of bromide of po- 
tassium ; one of which terminated fatally, the other 
resulting favorably. 

First Case. — This was a three-year-old boj T , a sister of whom 
had recently died of croup. The doctor saw the child on the third 
day of the disease. It was then- lying in a state of apathy upon 
its mother's arms, the countenance pale, the eyelids half closed, 
the hands hanging by the side. Suddenly the child became un- 
easy, put its hands up to its throat, and began to cry and to cough, 
but both cough and voice were toneless ; the child could be seen 
to cry and to cough, but it could hardly be heard to do so. The 
breathing was difficult, and marked by the peculiar rales of croup ; 
the pulse was small, barely to be counted, and gliding from under 
the finger. Examining the fauces, large white patches {plaques) 
covered the tonsils and the entire posterior pharyngeal wall. 
During the examination, the breathing became more difficult, and 
the child hurriedly but vainly gasped for air. An emetic had no 
effect. In spite of the unfavorable prognosis, an attempt was 
made to save the patient, and an inhalation of a solution of bro- 
mide of potassium, five grains to the ounce, was instituted. As a 
large proportion of the fluid struck the pharynx, it detached much 
of the patches, which was spat out. For two hours the child felt 
better, but soon the threatening symptoms recurred again, and in 
spite of five repetitions of the inhalation, the child died that night 
with symptoms of suffocation. 

Second Case. — This was a well-developed child, six months old, 
with pseudo-membranous croup. Inhalations of bromide of po- 
tassium, ten grains to the ounce of water, were administered. 

* Wiener medic-Halle, July, 1862, No. 29. 



SUITABLE FOR NEBULIZATION. 311 

After fifty to sixty inspirations, instead of the rales, a flapping 
respiration ensued, as from the air passing and repassing a mem- 
brane partially detached. Soon there was so much improvement 
that the cough was less frequent and the voice less hoarse. This 
improvement continued four or five hours, when the previous 
symptoms returned. Another inhalation produced the same re- 
lief, which continued throughout the entire night. The following 
morning the child's appearance was quieter, the pulse had gone 
down from 130 in the minute to 100, and voice and cough were 
somewhat hoarser, but the cough no longer so severe. Another 
inhalation produced again the same effect as before, but to a 
greater extent; another inhalation was given in the evening, fol- 
lowed by quieter sleep. Pulse in the morning, 96-100; two inha- 
lations during the day. The next morning, the fourth of the 
treatment, after the child had in all taken six inhalations, two 
ounces each time, the breathing had become quiet, pulse not ac- 
celerated, voice nearly as clear as natural, and the cough almost 
entirely gone. 

Camphor. 

Dose. — One grain to the ounce, in emulsion. 

Camphor has been used, with mucilage of gum arabic, 
in the putrid expectoration of phthisis (Fieber) ; but 
must be discontinued on the appearance of congestion or 
irritation. It is sometimes of use in spasmodic coughs. 

Oil of Turpentine. 

Dose. — One to five drops to the ounce of water. 

Oil of turpentine has been used with advantage in the 
dyspnoea of asthma, and in the chronic catarrh of em- 
physema (Leiblinger, "Waldenburg) ; in pulmonary 
phthisis with excessive secretion (Waldenburg) ; in 
chronic inflammatory affections of the air-passages gen- 
erally, especially when attended with offensive secre- 
tions, as in putrid bronchorrhoea and gangrene of the 
lungs. 



312 articles of the materia medica 

Oils of Pine. 

Dose. — The same as oil of turpentine. 

The oils of pine have been used for the same affections 
as are treated by oil of turpentine ; the oil from the Scotch 
fir being usually preferred, although the mountain oil, 
and other oils of pine, are sometimes employed for the 
same purpose. Lewin has tried oil of pine in alcohol as 
an excitant in aphonia, but without material result. 

Oil of Cade. 

Dose. — One to two drops to the ounce of warm water. 

The oil of cade has been recommended chiefly in the 
chronic catarrh of emphysema. (Leiblinger.) It is ap- 
plicable to the same affections as oil of turpentine and 
the like. 

Oil of Copaiba. 

Dose. — The same as the above. 

Oil of copaiba has been recommended in the same 
affections as oil of turpentine. (Trousseau.) 

Oil of Cubeb. 

Dose. — The same as the above. 

Oil of cubeb has likewise been recommended in the 
same affections as oil of turpentine. (Trousseau.) 

Creasote. 

Creasote. — Dose. — An ounce or so of a solution con- 
taining from one to ten drops to sixteen ounces of water. 

Creasote Water. — Dose. — One to ten drops to the 
ounce of water. 

Creasote is applicable to the same diseases as oil of 
turpentine, and, in addition, to the chronic laryngitis of 



SUITABLE FOR NEBULTZ ATION. 313 

phthisis, and to fetid eoryza. Mv friend, Dr. James 
Collins, of Philadelphia, has seen considerable benefit 
from the use of creasote water, five drops to the ounce, 
in the anginose form of scarlatina, even after the failure 
of other local remedies, such as chlorate of potassium 
and the like. 

Carbolic Acid. 

Dose. — One to two grains of the crystallized acid to 
the ounce of water. 

Carbolic Acid Water. — Dose. — Five to ten drops to 
the ounce of water. 

Carbolic acid is applicable to the same diseases as oil 
of turpentine and creasote, and is much more extensively 
employed than either. 

It is likewise recommended in diphtheria, fetid sore 
throat, and fetid eoryza. It has been highly recommended 
in all stages of phthisis. (Wolfe.*) Dr. Labort, of Yin- 
cennes, informed Dr. Wolfe that he had administered it to 
between two hundred and three hundred patients in dif- 
ferent stages of phthisis with marked benefit. Fifteen 
drops of the pure acid were dissolved in two ounces of 
spirit, and the solution mixed w T ith thirty-two ounces of 
water; and this amount was administered daily, partly 
by the stomach, and partly by inhalation in spray. 

Shortly after the publication of Dr. Wolfe's article, 
the inhalation was tried by Dr. J. Forsyth Meigs, of 
Philadelphia, both in the Pennsylvania Hospital and in 
private practice; and this gentleman informed me that 
he had found it of some value as a palliative in phthisis. 
This opinion is now pretty generally maintained. 

* Med. Times and Gaz., Nov. 25th, 1865; Brit and For. Med.- 
Chir. Rev., Oct. 1866, p. 538. 



314 ARTICLES OF THE MATERIA MEDICA 

I have sometimes used sprays containing a drop or 
two of the concentrated or deliquesced acid (Calvert's by 
preference) with from five to ten drops of the compound 
tincture of iodine to the ounce of water, twice or thrice 
a day, with considerable benefit, in chronic bronchitis, 
in the ulcerative laryngitis of phthisis, and in the ordi- 
nary purulent stage of the disease. 

Dr. William Marcet* reports favorably as to his own 
success in phthisis with the spray of solutions containing 
from one grain to a grain and a half of the crystallized 
acid to the ounce of water, once a day or once in two 
days, for fifteen or twenty minutes at a time. He does 
not recommend it in the first acute stage, or in the acute 
second and third stages. He thinks that a solution 
containing more than two grains to the ounce should 
not be used, on account of its depressing action on the 
cardiac pulsations. 

Ley denf has recommended the use of carbolic acid 
inhalations in pulmonary gangrene, the solution used 
containing from two to four per cent, of the acid, and 
the odor or taste masked, for sensitive patients, by pep- 
permint water. 

RiegelJ fully substantiates the exceedingly favorable 
results recorded by Ley den. 

Helfer§ has found these inhalations successful in 
severe cases of true croup. 

* The Practitioner, Nov. 1868, p. 265. 

f Ueber Limgenbrand. Volkmann's Samnilung klinischer 
Vortrage. 

J Ziemssen's Cyclopsedia, vol. iv, New York, 1875. 

I (Deutsche Klinik, 1871, No. 26) ; Waldenburg, op. cit., p. 40. 



suitable for nebuliz ation. 315 

Tar. 

Infusion of Tar. — Dose. — One to four drachms to the 
ounce of water. 

Tar-water is disinfectant, somewhat astringent, and 
slightly stimulant to the mucous membrane. It is em- 
ployed in non-febrile conditions of chronic inflamma- 
tions of the air-passages with excessive secretion. It is 
useful in the ulcerative laryngitis of tuberculous phthisis, 
in pulmonary phthisis (Waldenburg), in phthisis with 
purulent secretion and colliquative sweats (Lewin), in 
pulmonary gangrene (Waldenburg), in putrid bron- 
chorrhoea without fever (Waldenburg, Lewin), in dilated 
bronchi with emphysema. (Waldenburg.) Siegle terms 
it an antiseptic par excellence. 

I have witnessed excellent effects from the spray in ad- 
vanced stages of pulmonary phthisis with free secretion ; 
the expectoration, cough, and dyspnoea becoming less 
annoying, and the local comfort being materially in- 
creased. 

Lime. 

Solution of Lime. — Dose. — One ounce of the officinal 
solution, diluted, when necessary, with one or more 
parts of water. 

Lime-water is much employed as a detergent, and as 
a solvent of exudative products. Its chief employment 
is in croup and diphtheria. 

Prof. Biermer,* of Berne, relates the following inter- 
esting case of laryngeal croup in the adult, cured by 
inhalations of warm watery vapor and of lime-water. 

* Schweizerische Zeitung fur Heilkunde, 1864, p. 157; Lewin, 
op. cit. , p. 287, et al. 



316 ARTICLES OF THE MATERIA MEDICA 

A young girl of eighteen } T ears of age, was treated in the begin- 
ning of March, 1864, for what appeared to be a simple laryngitis. 
During breakfast on the morning of March 13th, there suddenly 
ensued an intense paroxysm of cough, with appearance of asphyxia, 
cyanosis, cool extremities, loss of consciousness, and complete in- 
sensibility. The physician who was called in the emergency, recog- 
nized the necessity of immediate resort to some powerful restora- 
tive, and applied a hot hammer upon the breast; but without 
exciting any reaction. Under continued severe irritation of the 
skin, and the use of liq. amnion, anisati, the patient gradually 
came to, and eventually coughed up a considerable quantity of 
croup membrane ; after which the respiration became easier. After 
this attack, the breathing remained stenotic, rattling, and whis- 
tling. On her reception into the hospital, the morning of the same 
day, the countenance was still very livid, the eyes dull, the pulse 
very feeble and small, the nose and extremities cool, and the crowing 
respiration was accompanied by paroxysms of cough, during which 
pseudo-membrane was expectorated. One patch was ring-shaped, 
having received the impression from one of the rings of the trachea. 
External irritation, and calomel, succeeded in diminishing the 
dyspnoea. The next morning, intense dyspnoea again set in, ac- 
companied with the ordinary croupal long-drawn inspiration, with 
the employment of all the auxiliary muscles, and marked inspira- 
tory incurvation of the scrobiculus cordis. In spite of the vomit- 
ing induced by an emetic, the orthopncetic symptoms increased, 
with lividity of the countenance and great distress during the 
continuance of the cough. Under these circumstances, in order 
to moisten the dry mucous membrane of the air-passages, the in- 
halation of warm water, broken up by the pulverisateur, was em- 
ployed. This agreed with the patient so well, that finally boiling 
water was permitted to be nebulized through the apparatus, for 
the patient declared that the warmest steam possible afforded her 
the greatest relief. She inhaled the warm steam for an hour with 
great eagerness, and expectorated to a considerable extent, while 
the dryness and difficulty of breathing gradually lessened. Then 
a stormy suffocative paroxysm of cough came on, during which a 
considerable quantity of mucus and pieces of croupal membrane 
were expelled. The patient then breathed much more freely, and 
felt greatly relieved. From this time on, she inhaled every two 
hours warm lime-water, in the proportion of one part to thirty, 
each inhalation continuing a quarter of an bour. From this time 






SUITABLE FOR NEBULIZ ATION. 317 

forward, the symptoms of croup declined more and more, and with 
a profuse expectoration of thick, crumby, yellow, purulent masses ; 
the fever abated, and convalescence began the following day; the 
aphonia, however, continuing until the 9th of April, when it also 
began to disappear. 

M. Biermer and all those who watched the progress 
of this case, were convinced* that the inhalations had a 
solvent effect upon the false membrane ; but the Pro- 
fessor does not recommend an exclusive adoption of this 
local treatment, which softens and detaches the exuda- 
tions, but does not reach the cause of the disease, which 
must be combated by constitutional remedies, calomel 
being considered the chief. 

Prof. Biermer was aware of the case of croup reported 
by Siegle, as cured by inhalations of nebulized water, 
very warm, and he attributes the happy result chiefly to 
the high temperature, especially when lime-water is 
added to it. 

Prof. Biermer was led to the employment of lime- 
water from the statement of M. Kuchenmeister,f of 
Dresden, that diphtheritic membranes are rapidly dis- 
solved in lime-water, j This was confirmed by Forster, 
of Dresden, and also by Prof. Biermer, who repeated 
Kitchen meister's experiments before the students of his 
clinical lectures in the University of Berne, placing 
some pseudo-membranous exudations in a small glass of 
lime-water; and they disappeared before the eyes of the 

* Brit, and For Med.-Chir. Keview, July, 1865, from Bui. gen. 
de therap., April 15th, 1865. 

f GEsterr. Ztscher. f. prakt. Heilkunde, 1863, Nos. 13 and 15. 

J (Dixon, in Duncan's Medical Commentaries, vol. ix, 1783-84, 
p. 254, recommends lime-water as the best solvent for bronchial 
casts.) Riegel, in Ziemssen's Cyclopaadia, vol. iv ; Bibliography 
of Croupous Bronchitis. 

27 



318 ARTICLES OF THE MATERIA MEDICA 

students in from ten to fifteen minutes, leaving only a 
slight sediment in the bottom of the glass. 

Dr. Brauser, of Ratisbon, has also published* the 
record of a case of croup in a child of four and a half 
years old, treated in the same manner, a perfect cure 
resulting:. M. Brauser insists on the necessity of using* 
the inhalations hot. 

Dr. James Collins, of this city, furnished me with the 
following record of his experience with inhalations in 
croup : 

Pseudo-membranous Croup. — Mary E , set. 11 months. Was 

called to the case November 18th, 1866. Patient apparently be- 
yond recovery. Lime inhalations employed with little or no effect, 
and the patient died. 

A. B- , set. 3 years. A robust, healthy child. Had been un- 
well for a few days, suffering from cough, neglecting its play, 
and becoming somewhat peevish ; but had shown no alarming 
symptoms until the previous night, when the cough became more 
brazen and spasmodic. I found the child with marked fever, 
dyspnoea, husky voice, distressing and spasmodic cough. On ex- 
amination I found the fauces lined with an albuminous deposit. 
Lime-water inhalations were at once instituted, and a mustard 
bath, while one of the family was dispatched for an emetic ; but 
by the time it was procured the symptoms had abated so much 
that it was not deemed necessary to administer it. The cough 
loosened, and tough albuminous material was coughed up in large 
irregular masses, which readily spread out into flakes on being 
spat into water. The inhalations were, continued every two hours 
that night, and three times the following day, after which I found 
no other topical application necessary. The inhalations were con- 
tinued from time to time, a mild purge administered, and turpen- 
tine stupes applied to the back of the neck and the breast. The 
child steadily improved and recovered. 

Dr. Collins informs me that he has since tried lime- 
water inhalations in several cases of croup, with success. 

* Quoted in Brit, and .For. Med.-Chir. Rev., July, 1865. 



SUITABLE FOR NEBU LIZ ATION. 319 

M. Kiichenmeister,* of Dresden, has published a case 
of diphtheritic pharyngo-laryngitis in a child of three 
years and a half old, treated with inhalations of lime- 
water with complete success. 

Dr. Da Costa, f of Philadelphia, has watched, in two 
cases of diphtheria, the action of lime-water on the 
visible deposits. 

In the first case, that of a lady, seen in consultation with her 
physician on the fifth clay of her confinement, the deposit covered 
the roof of the mouth, the half arches, and part of the wall of the 
pharynx. There was also, — and indeed the progress of the case 
placed the matter beyond doubt, — reason to believe that nasal 
diphtheria existed. She was taking chloride of iron, full nourish- 
ment, and stimulants. A stream of pulverized lime-water, about 
eight times stronger than that officinal in our Pharmacopoeia, — 
the saccharated solution of lime of the British Pharmacopoeia, — 
was directed upon the affected part by means of an excellent hand- 
ball atomizer for three or four minutes at a time. The treatment 
was carried on every few hours, but no perceptible influence on 
the membrane could be detected. The application was cleansing 
and very grateful, particularly so when thrown up the nostrils. 
The case terminated fatally, the membranes in the mouth remain- 
ing in a very thick layer. 

The second case was that of a gentleman thirty-five years of age. 
Here there was no nasal diphtheria, nor were the constitutional 
symptoms by any means so grave ; and after the disappearance of 
the membranes, which took place in about nine days, convales- 
cence was rapid. As local treatment, earl}'' in the affection, a 
strong solution of sulphate of copper was emploj-ed. But both at 
the time, and afterwards, Dr. Da Costa made use of nebulized so- 
lutions of lime, in the same manner as in the preceding case, and 
not hot. The remedy was again very grateful and cleansing; 
yet, though the same spot in the left half arch was repeatedly se- 
lected on which to throw the solution, no perceptible effect in 
thinning the deposit could be noticed from its influence. 

Waldenburg, on the other hand, claims j to have often 

* Brit, and For. Med.-Chir. Rev., July, 1865. 
f Op. cit., p. 32. % Op. cit, p. 416. 



320 ARTICLES OF THE MATERIA MEDICA 

seen the pseudo-membrane become smaller and thinner 
under his eyes, during the inhalation of sprays of lime- 
water, until it has finally disappeared entirely. 

It will be remembered that inhalation of lime-water 
has been proposed in cases of diphtheria, on account of 
its supposed solvent powers upon the diphtheritic mem- 
brane in situ. 

The solvent powers of lime-water, even upon pseudo- 
membrane in a test-tube, is too slow a process to meet 
the indications promptly, on this principle only, even 
were they as prompt upon the pseudo-membrane in the 
living subject. The solvent power in situ is very slight, 
perhaps prevented by the carbonic acid gas meeting it 
in the throat, larynx, trachea, etc., and converting the 
lime into its carbonate. The water, the gagging, and 
the coughing, are perhaps the efficient agents in the un- 
doubted beneficial action of lime-water. 

Dr. James Collins, of this city, has furnished me 
with the following notes of a case of diphtheria, in 
which lime-water inhalations were administered, under 
his treatment : 

Win, M , ;et. 3. When called to this little patient, Sep- 
tember 24th, 1866, I found him pallid, struggling for breath, with 
cold extremities, pulse 120 and feeble, and marked diphtheritic 
deposit lining the fauces and covering the tonsils. According to 
the mother's statement, the child had been " sickish-like " for ten 
days, but not sick enough to cause her to send for the doctor. I 
removed several large flakes of diphtheritic membrane with the 
finger very readily, gave injections of quinia and beef tea, ordered 
wine and water, and administered lime-water inhalations. The 
effect of the local treatment seemed to be quite marked. The dif- 
ficulty of breathing was greatly relieved ; the pulse became less 
frequent and fuller ; the skin became warmer, and for a time the 
child seemed to be relieved. During the night he again became 
worse and died. 



SUITABLE FOR NEBULIZ ATION. 321 

Dr. H. Ernest Schmid* has published a very instruc- 
tive case, illustrative of the good result of the persistent 
administration of inhalations of lime-water in mem- 
branous croup. 

My own experience with the inhalation of lime-water 
in croup has been quite limited, from the fact that I 
find such good results from the inhalation of warm air 
surcharged with steam, and the inhalation of the vapors 
from lime in the process of slacking, that I have no 
temptation to use the spray. I have, however, and that 
repeatedly, seen distressing symptoms of suffocation re- 
lieved by inhalations of lime-water spray, and have also 
seen copious expectoration of detached and broken-down 
or imperfect patches of membrane follow their use ; 
sometimes, indeed, tubular casts of the trachea, in one 
instance which recovered f as many as eight in succession. 

Waldenburg reports complete success from lime-water 
inhalations in a case of chronic croupous bronchitis. 

Sulphurous Acid. 

Dose. — Ten to forty minims, undiluted, or diluted 
with from one to ten parts of water. 

Sulphurous acid has been highly recommended in 
croup and diphtheria; and likewise in chronic pharyn- 
gitis, laryngitis, and bronchitis ; in asthma and emphy- 
sema; and in phthisis (Dewar).J' 

The method recommended by Dewar is to hold the 
nozzle of the nebulizer (Clarke's handball, or some sub- 
stitute) about six inches from the patient's mouth, and 

* The Medical Record, N. Y., 18G7, p. 78. 

f Seen in consultation with Dr. James Collins, of Philadelphia. 

% On the Application of Sulphurous Acid, etc., Edinburgh, 1868. 



322 ARTICLES OF THE MATERIA MEDICA 

to administer three or four whiffs of the pure acid 
(British Pharra.) to begin with ; then, after a corre- 
sponding interval, during which a cough or two is given, 
the process is repeated, about twenty squeezes in all, 
which represents the injection of from forty to sixty 
minims of acid. The inhalation is repeated hourly as 
long as required. In some cases of diphtheria it is re- 
peated with advantage as often as every fifteen minutes. 
I have employed these inhalations of sulphurous acid 
with good effects in some cases of diphtheria ; and at 
one time (several years since), when the disease was very 
prevalent in Philadelphia, kept a stock of the acid con- 
stantly in my house, so that I could employ it at the 
shortest notice. In chronic bronchitis, and allied dis- 
orders, I have not found it as efficacious as other treat- 
ment. 

Sulphuric Acid. 

Diluted Sulphuric Acid. — Dose. — One to ten drops to 
the ounce of water. 

Aromatic Sulphuric Acid. — Dose. — One to three drops 
to one to two ounces of water. 

The diluted sulphuric acid has been employed with 
some success in syphilitic laryngitis (Purdon). 

Lactic Acid. 

Dose. — Five to sixty drops to the ounce of water. 

Lactic acid has been recommended in croup and diph- 
theria for its solvent powers upon fibrinous exudations. 
(Brichetau, A. Weber.*) 

It is administered in doses of from fifteen to twenty 
drops in half an ounce of water, every half hour, de- 

* Centralblatt. f. med. Wissenschaft, 1869, No. 22. 



SUITABLE FOR NEBULIZ ATION. 323 

creasing the proportion of the acid to ten, and then to 
five drops, and increasing the interval between the in- 
halations, as improvement takes place. 

Quint a. 

Hydrochlorate of Quinia; Sulphate of Quinia — Dose. 
— One-fourth of a grain to two grains to the ounce of 
water. 

Quinia was tried by Fieber in a regularly recurring 
paroxysmal cough in a consumptive female (two grains 
of sulphate of quinia, seven drops of tincture of opium, 
five grains of alum, one ounce of spring water). . Haemop- 
tysis ensued on the same day in which it was adminis- 
tered, but whether the result of pulmonary congestion 
due to the quinia was uncertain. Quinia has likewise been 
employed by Sales-Girons in tuberculosis. As a matter 
of course it has been recommended in intermittent fever 
(Ancelon, Sales-Girons) ; but it is hardly necessary to 
intimate that inhalation is not a suitable method of usino; 
the remedy in that affection. 

Quinia has been recommended in so-called hay-fever 
(Binz, Helmholz), in the proportion of about one grain 
to an ounce and a half of water; in whooping-cough 
(Steffen); and in pneumonia, a one-half per cent, solution 
of the hydrochlorate of quinia. (Gerhardt.*) 

Opium. 

Extract of Opium. — Dose. — One-fourth of a grain to 
a grain to the ounce of water. 

Sedative Solution of Opium (Battlcy's). — Dose. — Two 
to twenty drops to the ounce of water. 

* Deutsche Zeitschrift f. pract. Med. ; La Tribune medicale, 
1874, No. 306; New York Med. Jour., Sept. 1874, p. 321. 



324 ARTICLES OP THE MATERIA MEDICA 

Tincture of Opium. — Dose. — Two to twenty drops to 
the ounce of water. 

Camphorated Tincture of Opium. — Dose.— Half a 
drachm to four drachms to the ounce of water. 

Acetate, Muriate, and Sulphate of Morphia. — Dose. — 
One-forty-eighth to one-eighth of a grain to the ounce 
of water. 

The preparations of opium are exceedingly useful as 
sedatives and narcotics in painful inflammatory affec- 
tions of the throat and air-passages, whether simple 
catarrhal, tuberculous, scrofulous, syphilitic, or cancerous. 
They are sometimes employed in whooping-cough and in 
asthma. They are also serviceable in irritative and 
spasmodic coughs, even the spasmodic cough of hysteria. 
They are frequently added to other solutions to relieve 
pain at the same time that the effort is made to combat 
morbid processes or ameliorate their manifestations. 
A favorite remedy with myself in the painful ulcerative 
laryngitis attending tuberculosis or disease of the car- 
tilages of the larynx, is the camphorated tincture of 
opium, a drop of the essence of peppermint being added 
to each ounce of the solution. 

In the follicular inflammation of the pharynx and 
larynx of public speakers and singers, I have seen good 
results follow the inhalation of a weak solution of opium, 
or some other narcotic, at a somewhat elevated tempera- 
ture, just before employment of the voice. 

The same may be said of the use of these sprays, just 
before eating, in the painful dysphagia of the chronic 
laryngitis of phthisis. 

They are sometimes remarkably useful, too, in acute 
affections. 

Thus, in a severe case of tonsillitis in a lady of this city who is 



SUITABLE FOR NEBULIZ ATION. 325 

subject to attacks of ulcerative tonsillitis, and several members of 
whose family I was attending during an epidemic of influenza 
some years ago, I succeeded in aborting the disease by strong in- 
halations of opium, employing a solution of five grains of the wa- 
tery extract to the ounce of distilled water, and repeating half the 
quantity at intervals of two hours. The relief to the pain, diffi- 
culty of breathing, etc., was very prompt, narcotism soon ensued, 
and after a sound sleep deglutition was again practicable, and in- 
halations of warm water simply were substituted for the opiate 
inhalations, of which she had taken but three, containing ten 
grains of the extract of opium ; but it must be remembered in con- 
nection, that the patient was in bed, took the inhalations from the 
side, and the probability is that not more than three grains at the 
utmost gained access to the parts, some of it being diffused in the 
air, and a good deal that entered the mouth being expelled again 
in expiration. 

In ordinary acute sore throat, I have often seen great 
advantage follow the use of the extract of opium in doses 
of a grain or less to the ounce. 

I have casually treated two cases of oedema of the 
larynx with opium. 

A lady in this city was carried out insensible from the upper 
story of a house on fire, in which very combustible materials, as 
soaps, oils, etc., were burning. The dense hot smoke from these 
substances had been inhaled, and had produced an intense laryngitis 
with complete aphonia. I was called to the patient a few hours 
after the occurrence, and found her exhausted, in great distress 
from d} T spncea, and threatened with death from suffocation. A 
solution of the watery extract of opium was immediately procured, 
and an ounce administered warm by inhalation, with relief to the 
suffering, and, to some extent, to the dyspncetic paroxysms. The 
inhalations were repeated eveiy half hour, for four or five times, 
until respiration had become markedly relieved, when they were 
given in a more diluted form every two hours. I paid the patient 
five visits within seven hours, and at each visit administered the 
inhalations mj-self, so as to insure the proper administration of 
some of them. The expressions of gratitude for relief were such 
as to leave no doubt as to their good result, and the patient would 
not have parted with the apparatus under any consideration. The 

28 



826 ARTICLES OF THE MATERIA MEDICA 

opium inhalations were continued three or four times a day for a 
week, when the acute symptoms of laryngitis having subsided, 
tannin was substituted, with the result of return of voice. 

Another lady in this city was sent to me by my friend and cola- 
borer, Dr. D. D. Richardson. The laryngitis in this instance was 
very painful, and complete aphonia had existed for five days. There 
was very great dyspnoea, so that the patient gasped for breath as 
she entered my consulting-room. She said that, several times, 
while on her way to visit me, she felt as though she would not be 
able to breathe any longer. A laryngoscopic examination revealed 
the aryteno-epiglottic folds very much swollen and inflamed, and 
the so-called false vocal cords so cedematous, as to entirely cut off a 
view of the true cords. This appearance was recognized by Dr. 
Henry V. Gray, of Petersburg, Va., who happened to be in my 
office at the moment, a gentleman who was, at that time, himself 
familiar to some extent with the use of the laryngoscope. In order 
to relieve the intense distress of the patient, I placed her before an 
apparatus from which a patient, but a few minutes before, had 
been inhaling a warm solution containing a drachm of laudanum 
to the ounce of water ; and set the pump going, while I was get- 
ting out my scarificator, with the intention of scarifying the swol- 
len structures. She could not have taken above half a dozen in- 
spirations, when she heaved a long sigh of relief, followed by a 
prolonged oh! and, continuing the inhalation, in a few minutes 
the dyspnoea had vanished, and the voice had returned, rendering 
scarification unnecessary; for on a second laryngoscopic examina- 
tion, the tumefaction was so much reduced as to forbid surgical 
interference. The result was unanticipated by myself, and Dr. 
Gray exclaimed, " Why, Doctor, that is magic!" 

A dose of sulphate of magnesia was ordered for the patient, and 
she was directed to use embrocations of the oil of turpentine ex- 
ternally for a few days. The trouble rapidly subsided after the 
single inhalation, so that its repetition was not requisite. 

It is my desire not to be misunderstood as recom- 
mending dependence upon sprays in the treatment of so 
formidable a condition as oedema of the larynx. The 
knife offers the proper means of relief, if the extent of 
the oedema is at all alarming, or even stationary and 
likely to become serious. 



SUITABLE FOR NEBULIZ ATION. 327 

Fieber reports* a case of laryngotracheal catarrh, 
with almost complete aphonia, in which the voice soon 
returned under the inhalation of a solution containing 
six drops of laudanum, and six grains of sulphate of 
zinc to the ounce of water. 

Fieber reportsf in detail a remarkable case of inferred 
phthisis, treated mainly by opium : 

A married woman, set. 38, was troubled with exacerbating par- 
oxysms of cough and vomiting, every night about three o'clock 
a.m. Her general condition was improved by tonics, — bark and 
quinine, — but without any impression upon the severity of the 
cough, or the amount of the sputa. Narcotics and demulcents were 
of no avail. Then, abandoning all remedies except the tincture 
of cinchona, Fieber instituted inhalations with the pulverisateur. 
Within twenty days the patient took, in all, 3635 inhalations (in- 
spirations); the smallest number in anyone day being 40; the 
largest, 300 ; the average, 240. This treatment began September 
12th, 1861, with 40 inhalations of the spray of pure water. Sep- 
tember 14th, 80 inhalations, consuming five minutes, of a solution 
of laudanum, three drops to the ounce of distilled water. The 
soothing effect being trifling, he increased the proportion to five 
drops, and on the 16th she took 80 inhalations, and the soothing 
effect was greater ; 17th, 100 inhalations in five minutes ; 18th, 5 
grains of alum was added to prevent too great a degree of somno- 
lence, which showed itself particularly towards evening ; and of 
this, 75 inhalations in four and one-half minutes ; 19th, 160 inha- 
lations in ten minutes; 20th, 21st, 22d, each day 240 inhalations 
in fifteen minutes. Now she coughed very little during the day, 
and the expectoration had decreased. The nightly paroxysms of 
cough had lost nothing of their intensity. He then determined 
to make an experiment with an antiperiodic mixture, and on the 
23d the patient took 200 inspirations of a fluid containing to the 
ounce of water two grains of the sulphate of quinia (of which 0.64 
grs. dissolved, the rest remaining suspended), seven drops of tinc- 
ture of opium, and five grains of alum. Nothing peculiar was 
noticed during the inhalation, but haemoptysis occurred on that 
day, and also on the succeeding day, in all together to the amount 

* Op. cit, p. 119. f Lewin, op. cit.. p. 244. 



328 ARTICLES OF THE MATERIA MEDICA 

of about four teaspoonfuls of blood, alkaline in reaction ; and 
there was increase of the catarrhal symptoms. The patient com- 
plained of the benumbing sensation produced by the alum, and of 
its taste ; and on the following day, September 25th, she took 120 
inhalations, in seven and one-half minutes, of a mixture of five 
drops of the tincture of opium, seven and a half grains of tannin, 
and one ounce of water. This solution was retained to the end of 
the treatment. The catarrh decreased ; the sputa showed less 
blood. September 26th, no blood in sputa ; catarrh trifling. The 
nightly paroxysm, suspended for an hour, appeared at four a.m., 
and was less intense than heretofore. Patient complaining of 
weariness, no inhalation ; 27th, 240 inhalations in fifteen min- 
utes, paroxysm again at four a.m.; 28th and 29th, same treat- 
ment, paroxysm came on at five a.m., and for the first time so 
modified that the patient did not vomit towards the last of it, as 
had been the case since June; on the 29th, the patient thought 
that she had overslept her paroxysm, but it came on, however, at 
six a.m. ; 30th, no inhalation ; the paroxysm came on at seven a.m., 
and was still weaker. October 1st, no paroxysm ; 240 inhalations. 
Patient can now inhale without producing the least disposition 
to cough, as had always been the case, more or less, until this 
day. She has been sleepier than usual for several days, owing to 
the effect of the opium inhaled. October 2d, 250 inhalations; 
3d, no inhalations; 4th, 5th, and 6th, each day 240 inhalations. 
At this point the treatment was discontinued, as there had been 
no paroxysm for several days, but little cough, and very trifling 
secretion. The percussion was the same as at the beginning of 
the treatment; but of the catarrhal rales, there remained only 
some rude respiration on the left side. 

The following case is from the same source : 

Tuberculosis of left huig, hcemoptysis, intense cough, -marked im- 
provement under inhalations of opium and alum. Patient, a man 
aet. 28, feeble, emaciated, tuberculous infiltration of left upper 
lobe, cough intense and painful, expectoration easy but very pro- 
fuse, pulse 120. Treatment began May 10th, with inhalations of 
two drachms of the tincture of opium to two pounds of distilled 
water, 20 inhalations in the morning and 10 in the evening, in- 
creased by the third day to 30 in the morning' and 20 in the eve- 
ning, with decrease in the frequency of the cough and in its in- 
tensity, decrease of moist rales, and reduction of pulse to 108. 



SUITABLE FOR NEBULIZ ATION. 329 

Now, two drachms of alum were added to the opiate solution ; 
expectoration decreased, strength increased. June 17th, 40 inha- 
lations in the morning, 30 in the evening. July 1st, 50 inhala- 
tions morning, 40 evening. July 2d, 50 inhalations morning and 
evening. Three grains of quinine were now added daily. Then 
the strength of the patient increased in a marked degree. After 
several nightly excesses, on July 9th a slight haemoptysis, not fol- 
lowed by any injurious results. Early in August the catarrh was 
reduced to a minimum, and the patient returned to his own 
residence. 

In the distressing cough of chronic bronchitis, espe- 
cially when accompanied by excessive pain, an inhala- 
tion of tepid or warm water, containing from ten to 
twenty-five per cent, of paregoric, or an equivalent 
quantity of extract of opium, or the like, will often 
prove grateful and efficacious. I have had excellent 
results from the paregoric in this way, especially when 
taken at short intervals (one to two hours), a few hours 
before the usual time of composure for sleep. 

Dr. Ludwig Joseph, of Breslau,* has employed a 
solution of acetate of morphia in bitter almond water 
and fennel-seed water, as recommended by Fieber and 
others, with good results in painful affections of the air- 
passages. 

Hyoscyamtjs. 

Extract of Hyoscyamus. — Dose. — One-fourth of a 
grain to two grains to the ounce of water. 

Fluid Extract of Hyoscyamus. — Dose. — Three to ten 
drops to the ounce of water. 

Tincture of Hyoscyamus. — Dose. — Two to ten drops 
to the ounce of water. 

Hyoscyamus is employed in the irritative coughs of 

* Deutsche Klinik, May 26th, 1866. 



330 AKTICLES OF THE MATERIA MEDICA 

catarrhal inflammations, and in spasmodic coughs gen- 
erally. It has been used by Fieber in whooping-cough, 
in severe bronchitis, and in bronchial catarrh attended 
with spasm; and by Leiblinger and Lewin in phthisis. 
It has also been employed in the cough and dyspnoea 
occurring in the intervals between the paroxysms of 
asthma (Waldenburg). 

Fieber reports* the case of a child four years of age, in whom 
the paroxysms threatened suffocation, and in which, the dispro- 
portion between the objective symptoms and the subjective phe- 
nomena leading him to consider the affection a disease of the par 
vagum, rather than of the minute bronchi and air-cells, he re- 
solved to employ inhalations of the following mixture: Alcoholic 
extract of the seeds of hyoscyamus, six grains ; olive oil, one fluid 
ounce; pulverized gum arabic, half an ounce; spring water, two 
pounds. After eight days' use, the disease had become so mild 
that further attendance was unnecessary. The emulsion was very 
well nebulized. Treatment began April 23d, 380 inhalations (in- 
spirations) readily taken ; no cough, narcotic effect produced. 
24th, same treatment; four spells at night, no blood in sputa; 
next night two paroxysms of cough. The cough worse in day- 
time while the child is moving about. 25th, 380 inhalations. 
2Gth, one spell during the night, less intense than before; 380 in- 
halations. 27th, child slept all night, 380 inhalations. This 
treatment was kept up until the 30th, with cessation of all the 
disagreeable sensations. 

As far as the palliative treatment of chronic phthisis 
by sprays is concerned, I have chiefly employed hyos- 
cyamus and infusion of wild cherry, with an occasional 
astringent when the expectoration was profuse and ex- 
hausting ; and tar-water as an antiseptic. The inhala- 
tion of warm water alone will facilitate expectoration. 
Nearly all of my cases have experienced great relief 
from the topical effect of the inhalations. 

In one case, that of a medical friend and former schoolmate, 

- Op. cit., p. 116. 



SUITABLE FOR NEBULIZ ATION. 331 

the relief to the dyspnoea from these inhalations was far greater 
than had been procured by any other method. This gentleman 
preferred the tincture of hyoscyamus, ten drops to the ounce of 
water, or of infusion of wild cherry hark ; and he often told me 
that the inhalation of half this quantity was sufficient to place 
him perceptibly under the narcotic influence of the hyoscyamus. 

Cannabis Indicum. 

Extract of Cannabis Indicum. — Dose. — One-fourth of 
a grain to a grain to the ounce of water. 

Tincture of Cannabis Indicum. — Dose. — Five to ten 
drops to the ounce of water. 

Indian hemp is sometimes employed in irritative 
coughs and spasmodic coughs, and Leiblinger has 
recommended the extract in the spasmodic cough of 
phthisis. 

Conium. 

Extract of Conium. — Dose. — One to six grains to the 
ounce of water. 

Fluid Extract of Conium. — Dose. — Three to eight 
drops to the ounce of water. 

Tincture of Conium. — Dose. — One to five drops to the 
ounce of water. 

Conium is recommended in very painful irritations of 
the larynx (Lewin), in hyperesthesia of the larynx 
(Waldenburg), and in asthma (Da Costa). I have found 
it useful in irritative coughs, and in the painful dysphagia 
attendant upon the chronic laryngitis of phthisis. 

Belladonna. 

Extract of Belladonna. — Dose. — One-fourth of a grain 
to one or two grains to the ounce of water. 

Tincture of Belladonna. — Dose. — One to ten drops to 
the ounce of water. 



332 ARTICLES OF THE MATERIA MEDICA 

Sulphate of Atropia. — Dose. — One-fortieth of a grain 
to the ounce of water. 

Belladonna has been recommended in the nightly irri- 
tative coughs of children (Sales-Girons, Blache), in spas- 
modic coughs, chiefly hysterical (Waldenburg), and in 
the dyspnoea of emphysema, associated with severe cough 
(Waldenburg). The sulphate of atropia recommended 
by some authors, is justly pronounced by Fieber as un- 
necessary and dangerous. 

Stramonium. 

Extract of Stramonium. — Dose. — One-fourth of a grain 
to a grain to the ounce of water. 

Tincture of Stramonium. — Dose. — One to ten drops to 
the ounce of water. 

Stramonium is sometimes used for the same purposes 
as other narcotics (Lewin), but has also been much used 
by some practitioners in asthma. Waldenburg has found 
it of service in the dyspnoea of emphysema. 

Digitalis. 

Extract of Digitalis. — Dose. — One-fourth of a grain to 
a grain to the ounce of water. 

Tincture of Digitalis. — Dose. — One to ten drops to the 
ounce of water. 

Digitalis is sometimes employed for the same purposes 
as other sedatives (Lewin). It has likewise been rec- 
ommended in tuberculosis, especially in the febrile con- 
dition (Gerhard t). 

Hydrocyanic Acid. 

Dilute Hydrocyanic Acid. — Dose. — One drop to one 
or two ounces of water. 



SUITABLE FOR NEBULIZ ATION. 833 

Bitter Almond Water. — Dose. — From a few drops to 
the ounce, to the full strength. 

Cherry Laurel Water. — Dose. — From a few drops to 
the ounce, to the full strength. 

Infusion of Wild-Cherry Bark. — Dose. — One or two 
ounces. 

The dilute hydrocyanic acid itself is rarely employed 
by inhalation. It has been recommended as a sedative 
(Fieber) ; but it requires care in its use, and it is better 
to resort to the other preparations mentioned, which con- 
tain the acid in smaller proportion. 

The bitter almond water is recommended by Lewin 
as a good menstruum for chloride of iron and other irri- 
tating remedies. Both this water and the cherry laurel 
water have been recommended by Siegle in excessive 
paroxysmal cough, especially that accompanying acute 
laryngitis and the laryngitis of phthisis, and likewise as 
a sedative in painful affections of the respiratory tract in 
general. 

I have used the infusion of wild-cherry bark with 
good results in the chronic laryngitis of phthisis, and in 
chronic, nervous, or habitual coughs of frequent occur- 
rence, but unattended with appreciable structural lesion. 

Lobelia. 

Tincture of Lobelia. — Dose. — Two to ten drops to the 
ounce of water. 

Lobelia has been recommended in asthma, and in the 
same diseases in which sedatives generally are employed 
(Lewin). 

Ipecacuanha. 

Wine of Ipecacuanha. — Dose. — Ten to sixty drops to 
the ounce of water, or five to thirty minims undiluted. 



334 ARTICLES OP THE MATERIA MEDICA 

Inhalation of the spray of wine of ipecacuanha, pure 
or variously diluted, has been found of great service by 
Drs. Ringer and Murrell,* in winter cough and bron- 
chitic asthma. When the undiluted wine is used, the 
patient is instructed to expectorate the residue that re- 
mains in the mouth, in order to avoid the nausea which 
may ensue from swallowing it. At first but a few (two 
or three to twenty) squeezes of the hand-ball nebulizer 
can be borne by the patient ; but the tolerance usually 
soon increases. The inhalation is at first employed once 
a day, or two or three times a day in bad cases, the in- 
tervals being increased gradually as improvement takes 
place. 

ASSAFCETIDA MIXTURE. 

Assafcetida mixture, in combination with peppermint 
water and castor water, has been used by Lewin, in 
asthma with emphysema. 

Summary. 

In reviewing the entire subject, as portrayed in the 
preceding pages, we may conclude that the employment 
of remedies in this form is by no means to be ignored or 
underestimated, as far, at least, as regards diseases of the 
respiratory passages ; that these inhalations are not to be 
used carelessly, for the reduction of tension in the air 
inhaled while loaded with nebula may induce conges- 
tion, which may prove detrimental, as mine case related 
by Fieber, in which haemoptysis was induced, and in the 
case related by Trousseau, in which fatal pneumonia 
was induced by the too frequent inhalation of an astrin- 
gent, and as shown in the experiments of Demarquay 

* The Lancet, Sept. 5th, 1874, p. 338. 



SUITABLE FOR NEBULIZ ATION. 335 

upon rabbits, in whom the inhalations produced pleuro- 
pneumonia; that there is indubitable evidence of their 
great value in certain forms of sore throat, and particu- 
larly so in children ; that they can be resorted to with 
confidence to restrain haemorrhage, to subdue irritation 
and inflammations, to relieve dyspnoea, to repress exces- 
sive secretion, to resolve exudation, — in fact, to do all 
for the respiratory mucous membrane that can be accom- 
plished for other structures by the application of moist- 
ure, simple and medicated; that under favorable condi- 
tions of system, apart from constitutional implication, 
they are directly adequate to the cure of chronic affections 
of the respiratory organs that are at all curable ; perhaps, 
in part, by inducing exercise of the parts as an essential 
element of the process, and thereby exciting restorative 
nutrition leading to resumption of normal function ; but 
that they are not, in themselves and by themselves, 
adequate to the cure of disease, independent of general 
treatment ; that they are less applicable to acute affec- 
tions than to chronic, except in so far as they palliate 
special symptoms or relieve them ; that they are less 
efficient than local applications by the mop or sponge, 
in cases of thickening, or ulceration, or other evident 
change of structure in parts within reach of the probang • 
and that, therefore, though not specific in the usual sense 
of the term, they are to be regarded as an invaluable 
addition to our approved methods of administering re- 
medial agents, and as such entitled to our favorable con- 
sideration. 

After an additional experience extending over ten 
years, I find no reason to alter the opinion expressed in 
the above summary, as it appeared in the first edition of 
this volume. 



336 INSUFFLATION OF POWDERS 



PART III. 

THE INHALATION OF POWDERS. 

The Insufflation or Inhalation of Powders in 
Affections of the Respiratory Organs. 

The earliest employment of powders by insufflation, 
in the treatment of diseases of the air-passages, is as- 
cribed to iEsculapius, who, according to Galen,* was 
accustomed, in cases of angina, to blow an astringent 
powder into the larynx by means of a bent reed ; a 
method considered something of a novelty, even at the 
present day. The remedies employed in this manner 
are said to have been chiefly nut-gall and myrrh. 

Aretseus, of Cappadocia, is said to have used a similar 
instrument in the latter part of the first century, and 
for the same purpose, especially in the laryngeal com- 
plaints of children. Darwinf constructed a box, in 
which powders were stirred up for inhalation by turning 
a cylinder of bristles, the mouthpiece for inhalation 
being at the top of the box, a second opening being pro- 
vided below for the passage of the atmospheric air ;| 
while in more recent times the former method was rein- 
troduced into practice by Bretonneau, Trousseau,§ and 
Belloc, followed by many others, who have devised in- 

* De compositione medicamentorium localicum, etc., lib. vii, 
Cap. 3. 

f Beddoes, op. cit., p. 143. J Waldenburg, op. cit., p. 305. 

| Traite pratique de la phthisie laryngee, Paris, 1837, p. 349 ; 
Traite de therapeutique et de matiere raedicale, Paris, 1841. 



IN DISEASES OF RESPIRATORY ORGANS. 337 

struments of various form and mechanism for the pro- 
pulsion of the powders. Quills, hollow reeds, and 
tubes of glass, metal, or hard rubber, are used for the 
purpose. Trousseau's instrument consists of a glass tube 
of convenient size, within one aperture of which is to 
be inserted from three to four grains of the powder to 
be used ; the other end is placed as far as possible within 
the mouth of the patient, who closes his lips upon it 
and takes a forced inspiration through the tube. Trous- 
seau recommends the medicinal powders to be rubbed 
up with sugar of milk, to give them sufficient body. 
His formulae are, for bismuth, 1 part to 1, 2, or more of 
the sugar of milk; for alum, 1 part to 2 ; for acetate of 
lead, 1 to 7; for calomel, 1 to 12; for red precipitate, 
sulphate of zinc, and sulphate of copper, 1 to 36; for 
nitrate of silver, 1 to 24-72. He employed the alum 
and bismuth in relaxed conditions of the mucous mem- 
brane, unattended with marked inflammation ; the salts 
of lead and copper, in cases of considerable inflamma- 
tion ; nitrate of silver, in cases of known or inferred 
ulceration ; the mercurial preparations, in syphilitic 
cases, and also in non-specific ulcerations. The insuffla- 
tions were made daily, or every other day, three or more 
grains of the powder being used at a time. 

Prof. Burow,* of Konigsburg, was in the habit of 
employing in this manner nitrate of silver, three grains 
to the drachm of sugar of milk, in chronic laryngitis. 
He reported a number of cases of several years' stand- 
ing, with almost complete aphonia, which were cured in 
a few weeks, with restoration of the voice even to pur- 
poses of vocal music. Finding with many of his pa- 

* Deutsche Klinik, 1853, No. 21. 



338 INSUFFLATION OF POWDERS 

tients an inability to inhale the powder by the methods 
previously recommended, and that in some cases the 
powder was actually blown out of the tube in expira- 
tion, he devised a special contrivance, composed of two 
parallel tubes, one furnished with a valve, so that the 
powder could not be blown out by expiration, but was 
compulsorily inhaled in inspiration. The quantity of 
the powder employed by him was as much as could be 
put in the nib of an ordinary steel pen ; and this amount 
was used daily. 

Pserhofer,* of Vienna, used a box similar to that of 
Darwin, and he not only treated laryngeal, bronchial, 
and pulmonary troubles by inhalations of powders, but 
also employed the respiratory tract for the introduction 
of medicines in the treatment of affections of other 
organs. 

Ebert,t of Berlin, employing the same mixture as 
Burow, three grains of nitrate of silver with a drachm 
of sugar of milk, placed the powder in a steel pen, 
which he inserted half way within a quill open at both 
ends. The quill was introduced within the mouth in 
such manner that the nib should lie over the root of the 
tongue, when the patient, closing his lips over the quill, 
and compressing his nostrils, inhaled suddenly and 
strongly. He found the patients' first attempt usually 
unsuccessful, the powder only getting upon the base of 
the tongue and about the pharynx, so that when nitrate 
of silver was used, the peculiar metallic taste was per- 

* Schmidt's Jahrb., 1856, xcii, p. 170. 

f Die Behandlung der Laryngitis mit Einathmungen von Ar- 
genticum Nitricum in Pulverform, Annalen der Charite Kran- 
kenhuuses, vol. i, 1854, p. 93; Am. Jour. Med. Sci., Oct. 1855, 
p. 515. 



IN DISEASES OF RESPIRATORY ORGANS. 339 

ceived in these parts; but generally after the second or 
third attempt the powder was more or less thoroughly 
inhaled, as evinced by spasm of cough, burning sensa- 
tion in the larynx, etc. Twelve cases of laryngitis are 
narrated, some in young and delicate females, in which 
satisfactory beneficial results followed this treatment. 
These details are reproduced by Lewin.* 

Lewin, of Berlin, uses a small tubulated retort for 
the inhalation of powders, a small tube passing through 
the stopper to the bottom of the retort in which the 
powder is placed, the patient inspiring forcibly through 
the beak of the apparatus. 

The glass tubes of Trousseau were straight, and there- 
fore better adapted for treating affections of the palate and 
pharynx, than those of the larynx and trachea. They 
have been modified by bending the terminal extremity so 
that it can be placed behind the epiglottis, or over the 
entrance into the larynx. Since the use of the laryngo- 
scope as an aid in making topical applications to the 
upper air-passages, these tubes have been made with 
flutelike extremities, the opening at the side presenting 
in any desired direction, so as to facilitate the propulsion 
of the powder upon circumscribed portions of the upper 
portion of the larynx. This refinement is hardly neces- 
sary, as the ordinary bent tube can be readily held in 
the proper position when it is requisite to limit the ap- 
plication in the manner indicated. Some practitioners 
still employ the method introduced by Stoerck, of Vi- 
enna, which is to attach rubber tubing to the proximate 
extremity of the insufflator, the free end of which is fur- 
nished with a mouthpiece which is placed in the mouth 

* Op. cit., pp. 126 to 136. 



340 INSUFFLATION OF POWDERS 

of the operator, who then blows the powder into the 
throat of the patient. This method moistens the insuf- 
flator, to which the powder sometimes sticks, so as to 
prevent its propulsion through the tube, and renders it 
extremely liable to become clogged. Then the powder 
is sometimes forced back into the mouth of the operator 
daring an expiration by the patient. To remedy these 
inconveniences, Czermak attached a rubber ball com- 
pressor to the flexible tubing, which is compressed at 
the proper moment. These latter methods are methods 
of insufflation, and not inhalation or aspiration. The 
movement of propelling the powder is a single move- 
ment, made during a normal or voluntary inspiration, 
or a voluntary pause in respiration. The patient, in 
some instances, can use the instrument with the com- 
pressor himself; but in general the application is made 
by the physician, or by an attendant who has been in- 
structed in the manipulation. The patient should re- 
strain the disposition to cough as long as practicable, so 
as to secure the retention of the powder, otherwise most 
of it will be expelled. The insufflation may be repeated 
several times in succession, with short intervals of rest, 
and be renewed once or twice a day. 

The most convenient insufflator that I know of is that 
of Gilewski and Rauchfuss (Fig. 28), which consists of 
a properly shaped tube, with a gum ball for the purpose 
of propelling the powder forwards. The powder is in- 
serted into a slot in the tube, over which a tubular cover 
slides after the introduction of the medicine, which can 
be propelled in any direction desired by arranging the 
apertures of exit at the distal extremity of the tube. 
The bulb was devised by Rauchfuss, who originally 
employed it as a reservoir also, and the slot by Gilew- 



IN DISEASES OF RESPIRATORY ORGANS. 341 

ski. Various modifications of Rauchfuss's insufflator 
have been made, but they possess no advantage, at least 
in my own hands, over the original instrument. 




Rauchfuss's Insufflator. 

A, compressing bulb ; B, slot covering D, aperture into which the powder is 
inserted ; C, shower of powder leaving the instrument. 



Mandl, Chambers, Fournie, and many others, have 
devised instruments for the same purpose. Millot* and 
Gellesf have devised insufflators attached to tongue 
depressors. 

Dr. T. K. Chambers, J of London, recommends the 
inhalation of a light innocuous powder, with which the 
required medicinal agent may be mingled. He found 

* Stance de PAcad^mie de medecine, Nov. 20th, 1867; Mandl, 
op. cit., p. 548. 

f Gaz. hebd., 1869, No. 10, p. 153, illustrated. 
X Lancet, 1848. 

29 



342 INSUFFLATION OF POWDERS 

most suited to his purpose the pollen of the lycopodium 
(elub-nioss), first allowed to imbibe as much as it would 
take up of a saturated solution of the substance to be 
employed (in the cases narrated, nitrate of silver and 
sulphate of copper, or a combination of the two), and 
then carefully dried, and afterwards reduced to an im- 
palpable powder. The plan recommended for the in- 
halation is, that the patient should introduce into his 
mouth, as far as may be without choking, the tube of a 
well-dried glass funnel, and draw in his breath strongly 
at the same moment that an attendant, or himself if 
able, dusts the powder into the funnel from a nursery 
puff-ball. To obviate the necessity for withdrawing the 
funnel during expiration, and to prevent the powder 
from floating about the room, an apparatus with a double 
valve, and a closed powder-box, allowing the powder to 
pass only from without inwards, may be employed in- 
stead of the funnel. 

Prof. Dickson* thinks he has seen inhalation of the 
finely levigated powders of cinchona, and the acetate of 
lead, useful in restraining profuse expectoration. 

Prof. P. H. Thomas, f of Baltimore, recommends to 
the notice of the profession the following simple and 
easy method of applying nitrate of silver to the air- 
passages, contrived and adopted by his brother, Dr. John 
Chew Thomas, of Baltimore. 

" Let a fine grindstone or emery-wheel be caused to 
revolve with great velocity, while a stick of the caustic 
is lightly held in contact with it. The effect w T ill be to 
convert the caustic into an impalpable powder, which 

* Elements of Medicine, 18-55, p. 624. 

f Transactions of the American Medical Association, 1855, vol. 
viii, p 591, with cut. 



IN DISEASES OF RESPIRATORY ORGANS. 343 

may be inhaled freely by the patient, who sits before 
the stone at a convenient distance ; from three to six or 
eight inhalations may be taken at a sitting, according 
to the effects, but it is recommended to desist after much 
cough is created, and the operation may be repeated 
every two or three days, according to the influence it 
exerts on the disease." 

It has been found, in Dr. Thomas's experience, to be 
well adapted to chronic inflammation of the larynx, 
trachea, and bronchi, rarely causing any more than a 
temporary irritation. He has also used it with good 
effect in recent hoarseness and slight inflammation of 
the palate and throat. In established acute inflamma- 
tion, depletion and general treatment should precede its 
employment. 

Dr. Thomas refers to a number of instances of slight 
but persistent affections of the larynx and trachea, which 
were accompanied with weakness of voice, hoarseness, 
inability to speak or read for any length of time, which 
were entirely cured by the use of this means ; also cases 
of chronic bronchitis, which had proved very obstinate, 
yielding perfectly to the steady use of the same agency. 
He does not claim that it can supersede the use of the 
sponge and caustic solution, but that in many of the 
slighter affections of the throat, it may enable us to dis- 
pense with the disagreeable necessity of using the mop, 
and that it is applicable to some cases to which the 
former method is not. 

Prof. Charles Matthews* describes and depicts an 
instrument of his invention, intended to facilitate the 
inhalation of the smoke of powders in a state of ignition. 

* Am. Med. Times, November 24th, 1860, p. 365. 



344 INSUFFLATION OF POWDERS 

It consists of two tubes of paper, to the outer of which 
is attached the mouthpiece, the powder being confined 
within the inner tube, upon lighting which the smoke is 
conveyed to the mouth through the interspace between 
the two tubes. Cubebs is preferred as tlie vehicle to 
give sufficient volume to the powder when employed in 
this manner, for cases where a gentle stimulus is desired ; 
though decayed wood, pine bark, etc., may be employed 
for the purpose. 

An important point to be determined, says Lewin,* 
in this connection, is whether the powder inspired re- 
mains in the respiratory tract, and is not again extruded 
by the waving outwards of the ciliary epithelium. That 
this latter occurrence is generally the case, continues 
Lewin, we know very well. A large quantity of minute 
dust is continually floating in the atmosphere, especially 
in crowded cities. Now, if all this were inhaled, and 
retained in the pulmonary organs, it would eventually 
produce fatal consequences, because the bronchial tubes 
would become more or less clogged up. Such a result, 
however, is avoided by our natural instinct of breathing 
through the nostrils. The hairs at the external orifices 
of the nostrils, and the projecting turbinated bones catch 
the particles of dust inhaled through the nostrils ; and 
these particles are subsequently ejected from time to time 
by a very familiar process. But after a certain num- 
ber of nasal inspirations, we find it necessary to gape or 
take a deeper inspiration than ordinary, for which pur- 
pose the mouth is more or less widely opened ; usually 
it is not very widely opened, and the soft palate not be^ 
ing raised very much, the dust taken in with the inspi- 

* Op. cit., p. 122. 






IN DISEASES OF RESPIRATORY ORGANS. 345 

ration strikes the velum, and becoming entangled in its 
rnucus, it is thrown upon the moist mucous membrane 
of the tongue, half arches, and pharynx; the dust that 
has proceeded farther, is arrested by the epiglottis, the 
ary-epiglottic folds, and the ventricular bands or false 
vocal cords. If, notwithstanding these hindrances, some 
of the dust reaches the larynx or trachea, it is detained 
by the moist mucous membrane, and is expectorated by 
hawking or coughing, or is gradually removed by the 
waving of the cilia. 

This is much less the case, and in some instances not 
at all the case, when the materials inhaled are soluble, 
and dissolve in the bronchial mucus before the cilia can 
expel them ; or when the matters are specifically too 
heavy to be moved by them ; or when too great a quan- 
tity has been inhaled ; or when the mucous membrane 
does not possess its full strength and capabilities. 

On these grounds, concludes Lewin, it would appear 
that the inhalation of powders can be employed for the 
purposes of local therapeutics. 

Experiments on Men and Animals, proving the 
Penetration of Powders into the Respira- 
tory Tracts. 

Any one can convince himself that powders can be 
voluntarily drawn at least into the upper air-passages, 
by directing the dust of some colored substance, as char- 
coal, for instance, across his mouth, and suddenly taking 
a deep inspiration. The irritation produced, and the 
spasm of cough accompanying it, will be proof positive 
that some of the suspended particles have been drawn 
beyond the glottis, while an examination with the laryn- 
goscope will show that some particles of the dust have 



346 EXPERIMENTS PROVING PENETRATION 

lodged upon the vocal cords, true and false, the greater 
proportion being spread on the anterior wall of the tra- 
chea, and very little reaching the posterior walls of the 
larynx. A large portion of the powder will, of course, 
have remained in the mouth, principally detained about 
the base of the tongue, and upon the soft palate just above 
the attachment of the uvula. 

A great many experiments have been made upon ani- 
mals who were forced to inhale powders, and in whom, 
after section, the presence of the powders has been dem- 
onstrated in the respiratory organs. 

The principal experimenter in this direction has been 
Fournie, and his reports have excited a good deal of 
attention among those interested in the question. 

" Dr. Edouard Fournie* has clearly ascertained that 
the dust of charcoal, flint, starch, etc., penetrates into 
the bronchi, and he has endeavored to render the fact 
available in the treatment of disease. In order to ob- 
viate any disagreeable sensation on the part of the 
patient, he recommends the medicinal powder to be 
breathed in a special contrivance which he describes. 
It consists of an oval wooden box, fitted with two tubes, 
so arranged that the patient breathes the air in the box 
mingled with the medicinal powder. Laryngoscopic 
examination, and the black expectoration after the use 
of the apparatus, when charcoal dust has been employed, 
proves that the dust has entered the respiratory passages. 
The same apparatus is available for the inspiration of 
volatilized iodine, and Dr. Fournie has also thus em- 
ployed for medicinal purposes, starch, alum, tannin, 
subacetate of lead, and nitrate of silver. The diseases 

* Union medicale, February 5th, 1863. 



OF POWDERS INTO RESPIRATORY TRACTS. 347 

which he has successfully treated have been cases of 
catarrh, bronchitis, and some of well-marked phthisis/'* 

Fournie inclosed the head of a coal-heaver, whose 
nostrils were first compressed by forceps (pince-nez), in 
a sack filled with a quantity of coal-dust, and then the 
sack was shaken over his head with a good deal of force. 
The man coughed and coughed, and seemed to feel very 
uncomfortable. After being allowed to breathe this 
atmosphere for three minutes, the sack was removed and 
an examination by the laryngoscope gave the following 
result : The tongue, soft palate, tonsils, and pharynx, 
were fully covered with a thick layer of coal-dust ; the 
epiglottis, aryteno-epiglottic ligaments, and the arytenoid 
cartilages, were marked with coal streaks at several 
places, and were very much reddened ; there was only a 
thin black streak over the right vocal cord. An exami- 
nation with the laryngoscope before the experiment, had 
shown the parts to be normal. This cleanness of the 
mucous membrane of the larynx contrasted very strongly 
with the condition of the trachea, the mucous membrane 
of which, particularly on its posterior wall, was almost 
entirely covered with coal-dust. This experiment was 
repeated by Fournie upon himself and others, with simi- 
lar results. f 

Dr. Moritz Rosenthal, J of Vienna, published the 
records of a series of experiments which he instituted 
upon rabbits, to determine the extent to which pulver- 
ulent substances could be made to penetrate into the 

* British and Foreign Medico-Chirurgical Review, July, 1863, 
p. 241. 

f Levvin, op. cit.. p. 121. 

X Schmidt's Jahrbucher, November, 1866, from Wien. Zeit- 
sehrift, 1866, No. 1. 



348 EXPERIMENTS PROVING PENETRATION 

respiratory organs. Some very finely pulverized char- 
coal, sifted through a cloth, was placed in a double linen 
bag, in which a moderately sized rabbit was confined. 
The bag, with its contents, was then whirled round 
for from fifteen to twenty minutes, after which the 
animal was killed by section of the spinal cord, and 
the respiratory tract examined from below upwards, to 
avoid the conveyance by the shears of any of the ma- 
terial from above downwards. The coal was found in 
the ventricles of the larynx, on the walls of the trachea, 
and on those of the larger bronchi. By the aid of a 
lens, it was detected in the interstitial lung-tissue, where 
it became still more evident upon microscopical examin- 
ation. Sufficient reasons are adduced to prove that the 
appearances were not due to the pigment matter nor- 
mally found in the lung-tissue of such animals. An 
animal which had been permitted to live for several 
days after having been similarly exposed to an atmo- 
sphere loaded with the charcoal-dust, was examined, 
but not a particle of coal w T as found in the larynx or 
trachea, although such particles were discovered under 
the microscope in various portions of the lung, and also 
imbedded in the muscular structure of the right ven- 
tricle of the heart, into which they had bored their way ; 
not, however, in that of the left ventricle. Another 
rabbit was compelled to breathe a mixture of coal and 
starch-powder for fifteen minutes, immediately after 
which it was killed, but afforded no evidence of starch, 
microscopically or chemically, in the lungs or in any 
other organ ; the starch had been detained in the mucus 
of the upper part of the air-passages. A large rabbit 
was made to breathe for twenty minutes an atmosphere 
in which six ounces of carbonate of lead was suspended. 



OF POWDERS INTO RESPIRATORY TRACTS. 349 

Evidences of the lead were found in the larynx, trachea, 
and main bronchi ; and the lung-tissue, when dried 
under the microscope, showed irregular masses of crys- 
tals, identical with those of the carbonate of lead. 

Dr. Rosenthal found that in foundries, in which the 
models are sprinkled all over with graphite before being 
cast, the sputa of the workmen were black- colored and 
somewhat greasy. On laryngoscopic examination, he 
found stripes of grayish-black dust collected upon the 
posterior pharyngeal wall, and also upon the epiglottis 
and the vocal cords, the mucous membrane covering 
which structures was greatly reddened. These work- 
men are well nourished as a general rule, not liable 
to pulmonary affections particularly, and tuberculosis 
among them is rare. The irritation from the inhaled 
graphite seems principally confined to the pharynx, 
larynx, and upper portion of the trachea. The writer 
then goes on to recount the effect of various occupations, 
where the atmosphere of the workroom is filled with 
dust; as those of bakers, grinders, apothecaries, etc. He 
believes that very often such substances inhaled, by keep- 
ing up a continued irritation of the bronchial mucous 
membrane, etc., affect the distributions of the vagus, 
recurrent, and hypoglossal nerves ; at times, even to the 
extent of producing paralysis. 

The investigation into the diseases to which workers 
in stone, glass, tobacco, coal, etc., are subjected, by 
Traube, Cohnheim, Leuthold, Kussman, Degen, Zenker, 
Selbman, Koschlakoff, Felbz, Hirt,* and many other 
Teutonic physicians who have given the subject great 
attention, prove, beyond the possibility of a doubt, that 

* Die Krankheiten der Arbeiter, Breslau, 1873. 
30 



350 PATHOLOGICAL PROOFS OF PENETRATION 

fine particles of dust gain entrance into the air-passages, 
inducing severe and often fatal affections. 

Pathological Proofs of the Penetration of 
Powders into the Lung-Tissue. 

It has been known, for centuries, that certain avoca- 
tions, in the prosecution of which the laborers are ex- 
posed to the inhalation of vegetable, animal, mineral, 
and metallic dust, — as in the grinding of grain, the mak- 
ing of coal-black, mining, working in coal, the manu- 
facture of grindstones, the grinding of metals, and so on, 
— are productive of certain pulmonic affections, due to 
the dust inhaled by the workmen during their employ- 
ment. Closer to our own century, and within it, we have 
the observations of Johnstone,* Beddoes,f Knight, J 
Gregory,§ Marshall, || Holland,!" and others, whom it is 
needless to enumerate. 

To come down to more recent evidence, a case prov- 
ing the penetration of particles of coal into the lung- 

* Some Account of a species of Piithisis Pulmonalis, peculiar to 
persons employed in pointing needles in the needle manufacto- 
ries. Memoirs of the Medical Society of London, 1790, vol. iv, 
p. 89. 

f Essay on the Causes, Early Signs, and Prevention of Pul- 
monary Consumption, London, 1799. 

J On the Grinders' Phthisis, in the North of England. Med. 
and Surg. Jour., Aug. and Nov. 1830; Am. Jour. Med. Sci., 
N. S., vol. ix, p. 248. 

§ Case of Peculiar Black Infiltration of the Whole Lung. 
Edinb. Med. and Surg. Jour., 1831, No. 109. 

|| Cases of Spurious Melanosis of the Lungs. The Lancet, May 
17, 1834. 

^ Diseases of the Lungs from Mechanical Causes. London, 1843. 






OF POWDERS INTO LUNG -TISSUE. 351 

tissue, from inhaling an atmosphere loaded with the 
substance, is reported in detail by Prof. Traube.* 

This case was a charcoal carrier, aet. 54, who had worked at his 
employment for twelve years, and in whose lungs, after death, 
particles of charcoal were detected. f For twenty years he had 
had a cough, and of late years had suffered with shortness of 
breath. For twelve years, and to within the last three months of 
his life, he had been almost constantly exposed to the dust of char- 
coal, and had often observed that his sputa were black. In his 
expectoration were found numerous free black particles, of very 
irregular, angular shape, and sometimes of large size. Some of 
these presented structural peculiarities identifying them with the 
wood of the Pinus sylvestris. Three months before his death he 
was attacked with pericarditis, and subsequently, double pleuritis, 
and finally, gangrenous erysipelas. At the autopsy, the lungs 
were found free from structural lesion, but almost everywhere of 
a dark black color. A copious amount of dark serous fluid exuded 
on pressure, staining the fingers black like India-ink, and exhibit- 
ing under the microscope black and red particles similar to those 
which had been found in the sputa. Some of these particles were 
firmly imbedded in the pulmonary cells, to which they had bored 
their way. Prof. Traube believes that derangement of the ciliary 
action of the bronchial mucous membrane is essential to the accu- 
mulation of carbonaceous matter in the lungs, inasmuch as many 
persons continually inhale fine dust in similarly loaded atmos- 
pheres without apparent suffering. 

A similar case occurring in Prof. Traube's Klinik is 
reported by Dr. Leuthold,J in which, during life, the 
particles of the coal were detected in the sputa upon 
microscopical examination; and at the autopsy, Dr. 
Cohnheim detected similar particles in the very stroma 
of the lungs, and in the bronchial glands, proving that 



f Schmidt's Jahrbucher, vol. 110, p. 299. 

% Berliner klinische Wochenschrift, iii, 3, 1866 ; Schmidt's 
Jahrbucher, Band 132, 1866, p. 163. 



352 PATHOLOGICAL PROOFS OF PENETRATION 

they had penetrated into the air-cells, and had bored 
their way through the walls of the alveolae. 

Dr. Peacock* reports the results of the post-mortem 
examination of a patient who died of millstone-makers' 
phthisis, at the age of thirty-seven, having commenced 
work at that trade in his twentieth year. Portions of 
the indurated pulmonary tissue, and of the diseased 
bronchial glands, were obligingly examined by Dr. 
Bristowe, Avho furnished the reporter with the following 
notes : " The diseased portions of lung were much indu- 
rated, having generally an opaque whitish hue, but 
being thickly studded with a black pigment. Under 
the microscope little or no trace of original lung-struc- 
ture was visible, but the diseased masses appear to be 
made up of dense, closely arranged, fibroid tissue, stud- 
ded here and there with numerous irregular groups of 
black pigment, and generally with an abundance of 
transparent granules and globules of various sizes. The 
tissues were rendered comparatively transparent under 
the influence of strong acetic acid, the fibroid tissue 
becoming a little expanded, and many of the granules 
and globules disappearing. The bronchial gland pre- 
sented characters identical with those of the diseased 
lung/' 

Dr. Peacock subjected portions of the indurated lung- 
tissue to ignition in the flame of a spirit-lamp. The 
white ash which remained, dissolved to a great extent in 
hydrochloric acid, and partly with effervescence; but a 
portion was left which was seen under the microscope to 
consist of small angular transparent granules, exactly 
resembling the finer portions of the silicious dust col- 



* Brit, and For. Medico-Chirurgical Review, vol. xxv, 1860. 



OF POWDERS INTO LUNG -TISSUE. 353 

lected from one of the workshops. Dr. Moldenhauer, 
assistant in the chemical laboratory at St. Thomas's 
Hospital, also subjected portions of the indurated lung 
to the action of fire and nitric acid, and found that a 
considerable quantity of gritty matter remained, which 
had an amorphous aspect under the microscope, and was 
inferred to be silicious. The bronchial gland did not 
contain any similar material. 

At a meeting of the Pathological Society of London, 
held May 16th, 1865, Dr. Greenhow exhibited two 
morbid pathological specimens, one being a specimen of 
diseased lungs from a case of grinders' asthma, and the 
other a specimen of coal-miners' black lung. To copy 
the account from the Transactions of the Society : 

" Specimen of Diseased Lung from a Case of Grinders' Asthma. — 
The specimen has been in my possession for some years. It was 
taken from the body of a razor-grinder, who had long suffered from 
grinders' pulmonary disease, but had died from an intercurrent 
attack of pneumonia. The portion of lung shown is from the 
upper lobe, near the apex ; it is consolidated, but some parts are 
harder than others, and it is intersected by a firm white band, 
apparently produced by the thickening of interlobular tissue. It 
is now of a dark bluish-gray color, but is paler than when fresh. 
On examination of a thin slice under the microscope, a few small, 
apparently crystalline bodies, irregular in size and shape, were 
seen imbedded in the tissue, which also contained numerous small, 
well-defined, black masses of various sizes, which gave the lung 
its peculiar dark color. On the supposition that these latter 
might be at least due to the presence of oxidized iron, a very thin 
slice of the lung was taken and immersed for some time in hydro- 
chloric acid; but on examination under the microscope, it was 
found still to present appearances identical with those already de- 
scribed. In order to determine the nature of the apparently crys- 
talline bodies, a small portion of the lung was carefully incin- 
erated in a porcelain crucible; it left a bright red ash, which 
partially dissolved in boiling hydrochloric acid, leaving a small 
residue that gravitated to the bottom of the vessel. On examina- 



354 PATHOLOGICAL PROOFS OF PENETRATION 

tion of this residue under the microscope, it was found to consist 
partly of an amorphous deposit, and partly of small angular masses, 
which reflected light powerfully, and polarized light transmitted 
through them. A portion of the residue being, at the suggestion 
of my friend, Mr. Heisch, lecturer on chemistry at the Middlesex 
Hospital, exposed in a shallow platinum. vessel to the fumes of 
hydrofluoric acid, was entirely dissipated, proving it to be silica. 
A comparative experiment was tried with a portion of ordinary 
lung (from a patient who had died in the Middlesex Hospital) 
which, when incinerated, left an ash not quite so red as that from 
the grinder's lung, and altogether soluble in boiling hydrochloric 
acid. The solution of the ash from both lungs gave faint indica- 
tions of the existence of iron, about equal in both cases ; but the 
absence of free particles of iron in the grinder's lung was deter- 
mined by bringing every part of the specimen into proximity 
with a delicate magnetic needle without causing any sensible 
disturbance. 

" The disease from which the patient had suffered appeared to 
have been chronic, or, as Kokitansky terms it, interstitial pneu- 
monia, and its cause was doubtless the inhalation of finely pul- 
verized grit, given off from the revolving grindstone while the 
man was at work, and which, as we have seen, was found in the 
lung after death, in the form of small angular particles of silica. 

" Specimen of Coal-miners' Black Lung. — This specimen, like 
the former, has been in my possession for some time. It was ob- 
tained from the body of a collier who had worked in the shallow 
and ill-ventilated coal mines near Wolverhampton, and was taken 
from the free margin of the upper lobe. The general color of the 
mass is dark blue, almost black ; but it was quite black when fresh, 
at which time a black juice could readily be expressed from its 
substance. The pleura is thickened, and the lung is traversed by 
some firm white bands, apparently formed by the thickening of 
the interlobular tissue. The lung cuts toughly, and is very firm 
and solid, but not uniformly so, some ill-defined harder portions 
being felt in the substance when handled. Under the microscope, 
the lung was seen to be studded with small black deposits, appar- 
ently irregular, both in shape and size, but the examination was 
not made until it had been for some time immersed in spirit. On 
boiling a small slice in strong hydrochloric acid, the black deposit 
was not affected. A portion of the lung when incinerated left a red 
ash, closely resembling the ash left from burnt coal. When boiled in 



OF POWDERS INTO LUNG-TISSUE. 355 

hydrochloric acid, this ash was partially dissolved, leaving a white 
or grayish amorphous residue, which did. not polarize light, but 
evidently consisted of silica, for it was dissipated, on being exposed 
to the fumes of hydrofluoric acid. 

" This case appears to have been assimilated in its pathological 
characters to that of the razor-grinder. The lung was similarly 
consolidated, and traversed by white bands. Whatever doubt may 
sometimes be entertained regarding the origin of the black deposit in 
the lungs of colliers, it appears quite certain that in this instance it 
arose mainly from the inhalation of finely pulverized coal ; for on no 
other supposition can we explain the presence of the very large amount 
of amorphous silica obtained from the incinerated lung. 

" Remarks. — The result of the examination of these specimens 
of lung accords with the history of the symptoms from which the 
several classes of operatives exposed to inhale grit, or other heavy 
dust, are practically found to suffer. The earlier symptoms are 
those of bronchial irritation, namely: slight dyspnoea, cough, and. 
scanty expectoration colored with the material inhaled. This ail- 
ment often proceeds so slowly and insidiously that the sufferer is 
scarcely aware of its existence until it becomes aggravated by some 
attack of catarrh, and more or less disables him from working. 
Hence, overlooking the previous indisposition, he, for the most 
part, dates the commencement of his illness from the occurrence 
of a cold. In a great many instances, and especially those in which 
the dust inhaled is of a light description, the disease often remains 
bronchial throughout, and presents only the ordinary characters 
of chronic bronchitis, with or without emphysema. But in other 
cases, and especially in those in which a heavy dust, such as that 
given off in the processes of razor-grinding or china-scouring, has 
been inhaled, chronic pneumonia supervenes after a time, and fre- 
quently proves fatal, either in consequence of an intercurrent at- 
tack of acute pneumonia, or after a long chronic course with 
symptoms resembling those of very chronic phthisis. Dyspnoea is 
always a very marked feature of such cases, and is sometimes so 
extreme as to prevent active locomotion, even while the patient is 
still able to continue his occupation. The physical signs are also 
out of all proportion to the amount of disturbance of the general 
health, which, in constitutionally sound subjects, is much less than 
in those who are the subjects of pulmonary disease arising from 
constitutional cachexia. Sometimes, even when the complaint 
appears to be far advanced, the discontinuance of exposure to the 



356 PATHOLOGICAL PROOFS OF PENETRATION 

determined cause, viz., the inhalation of dust, is followed by a 
most marked improvement in health." 

Prof. Zenker* relates in detail a case of an operative, 
set. 31, who had been employed during life in preparing 
the paper-books for the gold-leaf fabric, and who died 
in 1864, after an illness of eight weeks. The powder 
employed is that known as English red, a compound of 
iron, which is used in the form of a dry impalpable 
powder, and rubbed into the paper with felt. The 
atmosphere of the workroom becomes so filled with the 
dust as, in a few minutes, to dry the pharynx of strangers 
unaccustomed to the atmosphere. The lung of this pa- 
tient had a red color; and on chemical examination, 
Prof, von Gorup-Besanez found oxide of iron in large 
quantities as fine molecules in the air-passages, and to a 
greater extent in the lung-tissue itself; besides, also, in 
the bronchial glands, and still further ; showing that the 
particles, after penetrating the interstitial tissue, had been 
carried onwards by the lymphatic system. 

A solution, in hydrochloric acid, of 55 grammes of 
the incinerated ash of this lung-tissue, was found to con- 
tain 0.828 grammes of oxide of iron : therefore, 14.5 
grammes, or about half an ounce to 1000 grammes ; or 
in the proportion of three-fourths of an ounce in the 
entire lungs, which, in the present instance, weighed 
1500 grammes, the left lung weighing 720, and the right 
780 grammes ; much in excess of the normal weight of 
the female lungs, which, according to Krause, is 1050, 
according to Dieberg, 1073 grammes. 

In order to determine the specific gravity, a compara- 
tive experiment was made with the healthy lung of a 

* Deutsch. Arch, fur klinische Med., 1866, vol. xi, p. 116. 



OF POWDERS INTO LUNG-TISSUE. 357 

robust man of forty years of age, who died of another 
affection, and with the compressed lung of an old man, 
who died of pleuritic exudation, care being taken to 
remove by frequent washing, etc., all sources of error 
which might invalidate the experiment. The result is 
shown in the following table : 

A portion of the Of the Of the coin- 

oxidized lung; sound lung; press?d lung; 

Weighed in air, . . . 7.210 gr. 8.810 gr 12.02 gr. 

Weighed in water, . . 0.440 0.130 0.03 

Loss of weight in water, 6.770 8.680 1199 

The sp. gr. being . . . 1.065 1.015 10025 

To demonstrate more clearly the increased weight, 
equal portions were taken from the above specimens, and 
likewise from the sound lung of a boy of fifteen years of 
age, which were allowed to drop to the bottom of a glass 
cylinder, filled with water to the height of forty-five 
centimetres; when it was found that the oxidized lung 
fell in thirteen seconds, upon a first, second, and third 
trial ; that the piece of sound lung from the robust man 
aged forty, fell in twenty -six seconds on the first trial, in 
twenty-five seconds on the second trial, and in twenty- 
six seconds on the third trial ; the piece of sound lung 
from the boy aged fifteen, fell in thirty seconds on the 
first and second trials; and the specimen of compressed 
lung from an aged man fell in thirty-one seconds on the 
first trial, in thirty-two seconds on the second trial, and 
in thirty -two seconds on the third trial. 

A second case is related with similar results as to the 
detection of oxide of iron in the air-passages and lung- 
tissue, in a patient who had been employed in backing 
glass mirrors, the English red being used for the purpose 
of rendering the metal adherent. 



358 PATHOLOGICAL PROOFS OF PENETRATION 

The sputa of a similar operative, examined twelve 
hours after leaving off work, were found to contain the 
oxide of iron, upon chemical and microscopical investi- 
gation. 

The results of many other post-mortem examinations 
have given the same results. Thus may be mentioned 
the cases recorded by Pearson,* Bichat,f Laennec, Trous- 
seau, Erdmann,J Loewe,§ Brockmann,|| and many 
others. 

Dr. L. Petrenz,!" found stony concretions the size of a 
hazel-nut in purulent pulmonary cavities. 

With regard to the black pigmentary matters found 
in the lungs of deceased coal-miners, and others who 
have worked in atmospheres loaded with coal-dust, some 
authors deny altogether their penetration into the pul- 
monary organs ; others contend that they may be in- 
haled, but that, being insoluble, they are expectorated; 
others not only admit their penetration, but are of opin- 
ion that they accumulate, act deleteriously, and produce 
alteration of structure. 

Virchow is one of those who contend that these ap- 
pearances are not due to the inhalation of particles of 
coal-dust ; which, according to him, if inhaled, would be 
extruded with the bronchial mucus. He considers the 
affection pigmentary, and due principally to obstruction 
of the mitral valve dependent upon a chronic hyperemia 
of the lungs, the result of a detention of the blood in the 
pulmonary veins. 

* Philosophical Transactions, 1813, p. 160. 

f Traite d'anatomie dcscriptif, 1819, t iv, p. 22. 

J Journal der prakt. Heilkunde, Dec. 1831, vi, p. 3. 

\ Bd. lxxxvi, vi, p. 16. 

|| Die metallurgischen Krankheiten des Oberharzes, etc., 1851. 

^ Lewin, op. cit. , p. 11. 



OF POWDERS INTO LUNG-TISSUE. 359 

Bayle recorded two cases which he attributed to a 
circumscribed melanosis; and Laennec, in commenting 
upon this view, rather refers the black deposit, as at 
least in part due, to inhalation from the smoke of the 
lamp or other products of illumination in general use, as 
it was sometimes discovered in the lungs of nurses ac- 
customed to sit up at night with the sick. 

It is also found in the lungs of other miners, not 
colliers, who work with lamps suspended over their 
heads. 

Others, again, are of opinion that the carbonaceous 
material or lampblack thus inhaled, accumulating, forms 
a nidus for the attraction of further carbonaceous matter 
from the blood. This view seems to be worthy of a good 
deal of consideration, for it has been found that by wash- 
ing the lungs containing such deposits, two materials are 
secured — one a vegetable carbon not acted upon by the 
solvents which will readily dissolve the other or organic 
pigmentary matter. 

While it is true that much of the matters inhaled 
would be thrown out of the system with the bronchial 
secretions, it must be remembered that some portions 
will be too heavy to be cast out against gravity, by the 
mere motion of the bronchial cilia, while other minute 
sharp-pointed particles, will bore their way through the 
epithelium, and thus eventually become imbedded into 
the very pulmonary tissue, as indeed appears to have 
been the case in the examples cited, similar evidence to 
which can be readily increased by adducing further 
records. 

We know, too, that workmen who remain long at a 
time in apartments filled with fine dust, — for instance, 
bakers, weavers, chimney-sweepers, artificers in stone, 



360 PATHOLOGICAL PROOFS OF PENETRATION 

etc., — are peculiarly liable to diseases of the lungs. Thus 
Dr. Peacock,* calling attention to the form of phthisis 
to which the French millstone-makers are subject, ex- 
plains how it is contracted. The rough working of the 
stone is effected by a steel chisel, " the pritchel," which 
is struck by a metal hammer, and the surfaces are finished 
by picking with a double-pointed steel instrument fixed 
in a wooden handle — the " bill and thrift." As the burr 
is extremely hard (it is the "French burr/' situated in 
the Paris basin above the gypsum containing bones, and 
in strata of sand and sandstone, and is harder to work 
than gun-flint), every stroke of the chisel is attended by 
a flash of light and a cloud of dust ; and larger or smaller 
particles of stone, forming a sharp grit, are thrown off. 
Portions of the stone and of iron from the chisel not 
infrequently become imbedded in the hands of the work- 
men, so that the backs of the hands of those who have 
been long at the trade are studded with small bluish 
spots; and occasionally the men sustain serious injury 
to their eyes. The mortality of these workmen is very 
great, so that of fifty workmen, about twenty will die 
of pulmonary disease within a few years, and they sel- 
dom live beyond forty years of age, especially if they 
begin to work at the trade in early life before their full 
physical development has been acquired. Dr. Peacock 
found in four workshops forty-one workmen, of whom 
the eldest was but thirty-eight years of age, and those 
next oldest twenty-nine and twenty-eight respectively. 
Most of them had before them, on an average, but eight 
or nine years more of labor. It is a remarkable fact that 
these workmen, knowing their condition and the result 

* Brit, and For. Med.-Chir. Rev., vol. xxv, I860, p. 215. 






OF POWDERS INTO LUNG-TISSUE. 361 

of a continuance at their avocation, seem thoroughly 
satisfied with it. Their wages are high (5s. per day), 
their dwellings and workshops are healthy, and they are 
well clothed. They drink freely of ardent spirits, which 
is said to preserve their strength and enable them to 
exist longer. 

Prof. Dickson, of Jefferson Medical College, Phila- 
delphia, when lecturing upon the causation of disease, 
used to draw the attention of his class prominently to 
the fact that many diseases are necessary results of the 
occupations of civilized life, and he would instance the 
wet and dry grinders in England, who have long been 
doomed to premature old age and death, from the wear- 
ing away of the stone in "foam like surges," which fill 
the lungs and thus induce fatal disease;-— for a dry grinder 
rarely reaches thirty-five, or a wet grinder forty-five 
years of age; — quoting the following lines from Elliot's 
Corn-Law Rhymes, showing how these grinders, like the 
millstone-makers, continue at their trade on account of 
its high wages and the opportunity presented for afford- 
ing the means of alcoholic stimulation : 

"There draws the grinder his laborious breath; 

There, coughing, at his deadly trade he bends ; 
Born to die young, he fears nor man nor death; 

Despair and riot are his bosom friends. 
Bid science on his cheek prolong the bloom ! 

He will not live — he seems in haste to gain 
The undisturbed asylum of the tomb; 

And, old at two-and-thirty, meets his doom." 

As a pathological proof of the penetrability of fine 
powders into the respiratory passages, I may instance a 
number of cases which occurred in a family living over a 
perfumery store which caught fire in this city some 



362 ARTICLES OF THE MATERIA MEDICA 

years ago. The family breathed the stifling smoke, and 
ten of them who came under the care of Dr. W. W. 
Keene, Jr., and myself, were attacked with severe bron- 
chitis, with aphonia; and for several days subsequent 
to the accident they expectorated large quantities of 
black sputa, which were nothing more nor less than the 
carbonaceous matters they were forced to inhale during 
the conflagration, before they could be rescued. 

Prof. Da Costa, of Philadelphia, in a foot-note to the 
reprint of his essay on Inhalation, states that his atten- 
tion had been called by Dr. Fleming, of Pittsburg, to 
the rapidity with which men repairing copper work 
which had been used for steam, water, etc., become af- 
fected by the impalpable oxide of copper therein formed. 
Dr. Fleming himself, having been exposed for a few 
minutes to the same influence, and the quantity breathed 
having been very minute, was astonished at the great 
effect experienced ; constriction about the chest, most 
active salivation, and so on. 

Articles of the Materia Medica employed by 
Inhalation or Insufflation in Powder. 

Powders, in an impalpable form, can be taken with 
the inspiratory current into the bronchial tubes in small 
quantities. When the medicinal agent is too irritant in 
the undiluted state, or too small in bulk for convenient 
use, it may be rubbed up with rock candy, sugar of 
milk, talc, liquorice root, or some other indifferent or 
innocuous material. 

Care must be taken that none of the powder is swal- 
lowed, if of such a nature as to provoke nausea, or induce 
any injurious effect upon the stomach or the system at 
large. 



FOR INHALATION IN POWDER. 363 

The use of powders by inhalation or insufflation is 
limited. They are often more efficacious in acute affec- 
tions of the larynx than solutions ; and even in chronic 
affections are sometimes better borne, though the general 
indication for their use is less frequent. 

The remedies thus employed in the form of powder 
are not very numerous, and the reports of their thera- 
peutic uses are quite meagre. 

The following list comprises nearly all of them. 

Alum. 

Alum is used pure or diluted with one or more parts 
of su^ar of milk or some indifferent material. Burned 
alum is sometimes used in preference. It has been em- 
ployed in coryza, catarrhs of the pharynx, larynx, etc., 
in aphtha?, in tonsillitis, the sore throat of small-pox, 
cedema of the glottis (Laennec*) ; and in croup and 
diphtheria (Pommier, Bretonneau, Trousseau), fifteen 
grains with sugar being blown on the parts several times 
a day in diphtheria. 

Tannin. 

Tannin is used alone or diluted with sugar of milk, or 
combined with other ingredients, as alum, borax, and 
the like. It has been employed in chronic and fetid 
coryza. Some authors have recommended equal parts 
of tannin and camphor, with double the quantity of 
high-dried Scotch or Welsh snuff in chronic coryza, a 
pinch being snuffed up into the nostrils when they are 
more obstructed than usual. I have occasionally seen 
benefit from the practice. It is sometimes employed in 

* Eev. med., Oct. 1828; Am. Jour. Med. Sci., vol. iv, p. 500. 



364 ARTICLES OF THE MATERIA MEDICA 

combination with equal parts of alum or borax, or rub- 
bed up with mallow root, two to five grains to the 
drachm, a pinch being snuffed up the nostrils, three or 
four times a day, in coryza. It is sometimes used in the 
same manner after the evulsion of nasal polyps. Wal- 
denburg has reported good results under such circum- 
stances. In fact, the insufflation of pulverized tannin 
was at one time extolled as a remedy capable of destroy- 
ing these polyps,* several cases of apparently perma- 
nent cure having followed a treatment extending from 
ten days to a month. Of late, little has been heard of 
this remedy in the connection alluded to; but although 
it may be incompetent for the destruction of polyps, it 
is certainly capable of modifying the catarrhal condition 
of the membrane upon which the existence of these 
growths in great part depends ; and hence it is of good 
service as an application to the parts after the removal 
of the growths. 

Powdered tannin is likewise occasionally employed 
with more or less benefit in chronic catarrhal inflamma- 
tions of the pharynx and larynx. 

Borax. 

Borax, pure, or mixed with equal parts of sugar, 
alum, or tannin, is used in aphthae, coryza, and catarrhal 
inflammations of the pharynx, larynx, and trachea. 

Bismuth. 

The subnitrate of bismuth, one part to one, two, or 
more parts of sugar of milk, or the like, was much used 
by Trousseau in relaxed conditions of the mucous mem- 



Bryant, The Lancet, Feb. 23d and Aug. 24th, 1867. 



FOR INHALATION IN POWDER. 365 

brane of the nose and pharynx, unattended with marked 
inflammation. Dr. Ludlow, of Philadelphia, has used 
this preparation locally wi^h much success in chronic 
affections of the nasal mucous membrane, led thereto by 
its peculiar sedative influence on the gastric mucous 
membrane when taken internally. It is sometimes used 
to give body to more active powders, when it is desirable 
to reduce them. 

Xitrate of Silver. 

Nitrate of silver in powder is usually employed, diluted 
with from twenty-four to seventy-two parts of sugar of 
milk (Trousseau), with five to twenty-five parts of burnt 
alum (Waldenburg), or with from one to six parts of 
commercial talc (Bruns). Some practitioners use less 
sugar, from one to ten (Barbier), or from five to twenty- 
five parts (Waldenburg). 

Trousseau employed this agent in cases of known or 
inferred ulcerative inflammations of the pharynx and 
larynx; BuroAV, in chronic laryngitis, three grains to 
the drachm ; Ebert, in laryngitis,* in the same propor- 
tion ; Thomas, in chronic inflammations of the upper 
air-passages, a few whiffs of the impalpable powder un- 
diluted; Barbier, in coryza, one part to ten, a pinch 
three or four times a day ;f Bruns, in chronic inflamma- 
tions, beginning with six parts of talc, and gradually 
reducing the proportion of the talc to equal parts; Wal- 
denburg, in catarrhs, one part to from five to twenty of 
the excipient. Pserhofer reportsj several cases of pul- 
monary gangrene successfully treated by inhalations 
(from a box) of a pow T der composed of one part of nitrate 

* Am. Jour. Med. 8c., Oct. 1853, p. 515. 
f Edinb. Med. Jour., May, 1872, p. 1049. % Loc. cit. 

31 



366 ARTICLES OF THE MATERIA MEDICA 

of silver with from four to six parts of lycopodium ; and 
likewise cases of chronic catarrhal bronchitis, tubercu- 
losis, etc. 

Mercury. 

Mercury is usually employed in the form of calomel ; 
but sometimes in the form of the red oxide also. Trous- 
seau employed the former in the proportion of one part 
to twelve of sugar of milk, and the latter in the propor- 
tion of one part to thirty-six. Calomel is sometimes 
used pure, or diluted with but one to five parts of sugar 
of milk or ordinary white sugar. Trousseau employed 
these mercurials not only in syphilitic cases, but in non- 
specific ulcerations also. He likewise employed them in 
fetid coryza, a pinch of the powder being snuffed up 
from ten to twelve times a day. Bretonneau* employed 
calomel powders by insufflation in diphtheria, both 
laryngeal and nasal, and also blew them into the trach- 
eotomy wound in cases that had been operated on ; as 
much as from tw T enty to forty grains, with powdered 
gum, being inhaled during the treatment of the case. 

Waldenburg w T armly recommended calomel by insuf- 
flation in syphilitic affections of the mouth and nostrils, 
one part to ten of white sugar. 

Antimony. 

Preparations of antimony are sometimes of great ser- 
vice in the early stages of acute laryngitis and pharyn- 
gitis ; and they may be combined with hyoscyamus and 
the like, to relieve pain, and with chloride of ammonium 
to promote secretion. The oxysulphuret is the prepara- 

* Op. cit., p 141. 



FOR INHALATION IN POWDER. 367 

tion that I have usually employed, rubbed up with from 
one to four parts of pulverized liquorice root, or some 
other indifferent material ; a pinch or so every three or 
four hours. 

Sulphur. 

The insufflation of powdered sulphur has been rec- 
ommended in croup and diphtheria. First employed 
by Barbosa in 1867;* it was brought into notice by 
Ullersperger,t and especially by Lutz^J who vaunts it 
as almost a specific cure. Loeviuson§ and others, in- 
cluding myself, || have also reported successful experience 
in the treatment of diphtheria with powdered sulphur. 
Hannerlf denies its beneficial influence on the disease. 

Morphia. 

Acetate, Muriate, and Sulphate of Morphia. — The salts 
of morphia are usually rubbed up with some indifferent 
powder as gum arabic, lycopodinm, or the like. Fieber 
recommends from one-sixtieth to one-fifteenth of a grain 
of the acetate or muriate at a time, with one-third of a 
grain of oxide of zinc, in irritable sore throats. 

Prof. Schrotter,** of Vienna, recommends the local use 
of powdered morphia to relieve the pain, in cases of 

* Gazetta medica de Lisboa, March, 1868. 

f Journal f. Kinderkr., 1868. 

X Die Epidemische Diphtheritis and ihre schnellste Heilung, 
Wiirzburg, 1870. 

I Berlin klin. Woch., 2, 1872. 

|| Diseases of the Throat, New York, 1872, p. 101. 

\ Journal f. Kinderkr., 1870, 1, 2. 
** Jahresbericht der Klinik fur Laryngoskopie, an der Wiener 
Universitat, 1870, p. 58. 



368 ARTICLES OF THE MATERIA MEDICA 

ulcerative laryngitis, in the proportion of from one to 
four grains to the ounce of some innocuous material, a 
suitable portion of which he propels from an insufflator 
directly upon the ulcerated parts. He prefers gum 
arabic or sugar as his menstruum. Sugar, however, 
sometimes increases the suffering for the time, although 
it also seems at times to exert a beneficial influence on 
the ulcerative action, facilitating the discharge of the 
slough. Gueneau de Mussy* and others recommend the 
insufflation of morphia into the nostrils in the treatment 
of facial neuralgia, a pinch, every two or three hours, of 
a powder composed of one part of morphia to twenty of 
pulverized mallow root. 

Of Other Remedies employed by "insufflation or 
inhalation, we may mention 

Camphor, alone, or with tannin or snuff, in acute 
coryza and chronic nasal catarrh. 

Myrrh, which, according to Waldenburg, deserves 
to be used in many cases of catarrh with copious secre- 
tion. 

Common Salt, in coryza. 

Chlorate of Potassium, in aphthae and diphtheria. 

Carbonate and Bicarbonate of Sodium, in 
coryza and catarrhal pharyngo-laryngitis. 

Chloride of Ammonium, in coryza, and in pharyn- 
gitis sicca. 

Acetate of Lead, one part to five or more of sugar, 
in chronic coryza, and in catarrhs with copious secretion. 

Sulphate of Iron, one part to twenty or more, in 
chronic coryza, and less diluted, even pure at times, in 
cases of multiple nasal polyps, after removal of the main 
masses. 

* Gaz. des hop., June and October, 1867. 



FOR INHALATION IN POWDER. 369 

Sulphate of Zinc ; Oxide of Zinc. — The prepa- 
rations of zinc are employed undiluted, or mixed with 
from one to thirty-six parts of sugar of milk, alum, 
tannin, or the like. They have been chiefly employed 
in catarrhal inflammations (Trousseau, Fieber). 

Salicylic Acid has been employed with advantage 
in fetid coryza, after due cleansing of the parts from 
mucus, pus, and the like. A pinch is snuffed up, at in- 
tervals, of a powder containing one part each of salicylic 
acid and lycopodium to four of starch, or six of subnitrate 
of bismuth (Ludlow, of Philadelphia). 



PART IV. 

MEDICATED ATMOSPHEEES. 

Atmospheres naturally or artificially impregnated 
with medicinal agents, are frequently prescribed for the 
treatment of affections of the respiratory organs, and 
sometimes for the treatment of other affections also. The 
patient either resides permanently, or for a time, in the 
medicated atmosphere, or else passes a certain number of 
hours a day in it during the continuance of the treat- 
ment. 

Among the ancients, Aretseus, Celsus, and the elder 
Pliny recommended sea-air in consumption, and Pliny 
likewise recommended residence in pine-forests as more 
beneficial than a voyage to Egypt, or a course of milk 
in the mountains. Galen not only recommended patients 
with phthisis, and with laryngeal and tracheal ulcera- 
tions, to reside on the sea-coast ; but also sent them to 
the vicinity of Mounts Vesuvius and JEtna that they 
might breathe, in addition, an atmosphere impregnated 
with sulphurous emanations. From time to time, simi- 
lar atmospheres have been recommended in various 
chronic diseases of the respiratory organs ; and where 
the natural atmospheres were out of reach, artificial sub- 
stitutes have been resorted to. 

Thus, "aspiratory chambers" have been found in the 
remains of many Roman baths.* 

* Sales-Girons, Therapeutique Respiratoire, Paris, 1858. 



MEDICATED ATMOSPHERES. 371 

Nicolas Piso (1527-1579) recommended hot dry air 
in consumption, and mentioned a case of recovery in a 
female, in consequence of her attendance on a bakehouse. 

Bennett, of London (1654), expressed the belief that 
by the use of suitable vapors or medicated effluvia, sit- 
ting apartments might be made useful substitutes for 
voyages to Egypt and other warm countries. 

Bartholin (1654) likewise thought that by the use of 
proper vapors, a sitting-room might be made a substitute 
for a voyage to Egypt. 

Atmospheres impregnated with the fine dust of fresh 
earth in suspension, as first recommended by Solano, of 
Luque, in the form of the earth-bath, were considered 
as possibly salubrious by Van Swieten, and were recom- 
mended by Fouquet, Hufeland, and others in phthisis. 
They are still employed at Ischl and other resorts on 
the European continent. Demarquay* believed that the 
beneficial effects of the emanations from earth-baths are 
due to the carbonic acid of which they are in great part 
composed. 

Residence in the immediate vicinity of cow-houses, 
stables, and the like, or even in apartments directly 
communicating with them, so that the atmosphere 
breathed by the patient should be continuously impreg- 
nated with the warm ammoniacal emanations from the 
animal exhalations, were highly recommended in phthisis 
by Read,f Beddoes, J and others, in the latter part of the 



* Essai de pneumatologie medicale, Paris, 1866, p. 471. 

f Essai sur les effets salutaires du sejour des etables. London 
and Paris, 1767. 

J On a new method of curing Pulmonary Consumption, hnd the 
Cow-stable Cure, Bristol, 1793. 



372 MEDICATED ATMOSPHERES. 

eighteenth century ; but this plan of treatment, though 
at one time vaunted as highly successful, soon fell into 
disrepute, and subsequently into disuse. The beneficial 
results from the practice were at first attributed to the 
ammoniacal and other animal exhalations. Fourcroy, 
however, shrewdly suspected that they were rather due 
to reduction of the purity of the atmosphere, which might 
be too rich in oxygen ; while Beddoes attributed them 
to the uniform warmth of the atmosphere, by the artificial 
maintenance of which, in other manners, he was able to 
obtain equally good results. 

In a similar manner, sojourn or residence in sugar 
manufactories was recommended in consumption by 
Beddoes and others, for the sake of the carbonic acid 
with which the atmosphere of such establishments is im- 
pregnated. 

The warm vapors from tanneries were recommended 
in like manner by Elliotson and others ; — and the list 
might be further increased. 

In the foregoing pages, mention has been made of 
atmospheres artificially impregnated with aromatics 
(p. 180), balsams (p. 133), bromine (p. Ill), camphor 
(p. 166), carbolic acid (p. 155), carbonic acid (p. 87), 
carburetted hydrogen (p. 87), chloride of copper (p. 177), 
chloride of ammonium (p. 116), chlorine (p. 31), hydro- 
gen (p. 83), iodine (pp. 97, 101), oil (p. 139), ozone (p. 
136), resins (p. 136), salt (p. 270), sulphur (p. 112), 
sulphuretted hydrogen (p. 83), tar (p. 140), turpentine 
(p. 144), and vapor of water (pp. 177, 183). 

The experiments of Laennec to produce an artificial 
sea-air for consumptive patients (p. 97), though not 
promising in their results, have been imitated by others, 



MEDICATED ATMOSPHERES. 373 

but in a different manner. Thus Hirzel,* of Zurich, 
sprinkled an artificial sea-water from a small fountain, 
in the apartments of consumptive patients. He was fol- 
lowed by others; and various establishments have been 
constructed at certain European thermal and other 
springs, where there are so-called " vapor promenades," 
as at Ischl, Nanheim, etc., the saline constituents of the 
mineral waters being forced up mechanically in the va- 
pors which rise from the boiling springs. In other 
places the water is boiled, and the vapor conducted into 
apartments to which the patient resorts to breathe in the 
impregnated atmosphere. 

Then, there are establishments in which salt-water 
sprays are continuously being projected into the atmos- 
phere to which patients resort at certain hours of the 
day, remaining in the atmosphere for an hour or so at a 
time. One example will suffice for the whole : 

"At Reichenhall, a celebrated cure in Bavaria, f a 
method of treatment is adopted in which the patient 
lounges in the immediate neighborhood of the drying- 
houses near enormous hedges, forty or fifty feet high, 
composed of bundles of twigs arranged horizontally, so 
that their projecting ends form the surface of the wall. 
The water is conveyed to these hedges by pipes, and is 
allowed to trickle over the bundles of twigs into reser- 
voirs, whence it is conveyed into vats, and undergoes 
further evaporation by the aid of heat. The air is richer 
in suspended saline particles (0.054-0.123 grains in the 



Lungen- und Luftrokrenschwindsucht. Schweizer Cant.-Ztschr. , 
1845, Nos. 1, 4; Schmidt's Jahrb., Bd. li, p. 284. 

f J. Burdon-Sanderson, Practitioner, London, Oct. 1868, p. 217. 

32 



374 MEDICATED ATMOSPHERES. 

cubic foot) than sea-air is. The researches of Prof. 
Vogel and Dr. von Liebig show that about ten grains of 
salt are actually taken into the respiratory apparatus in 
the hour; which is only two grains less than the amount 
taken in when the water is nebulized into spray in the 
inhalation rooms of the cure. Dr. Sanderson believes 
that the beneficial results of the saline atmospheres are 
due to their effect in increasing the tendency to molec- 
ular disintegration, i. e., to oxidations throughout the 
body. These inhalations are of great value in chronic 
catarrhal affections of the digestive and respiratory mu- 
cous membranes." 

Similar vapor promenades are established at Kreuz- 
nach, Kosen, Elmen, Salzungen, and other German 
resorts. A patient of mine, who spent some time re- 
cently at the cure at Salzungen, reported to me, on his 
return, that the ground became very wet, and that despite 
the precautions taken with water-tight shoes and the 
like, he found the ill effects from saturation of his feet 
more than counteract the good effects from the inhalation 
of the saline atmosphere. 

In cases of infective and contagious diseases, and 
under other circumstances in which it is desirable to pre- 
vent contamination of the atmosphere with the emana- 
tions from a patient or his discharges, or when it is 
desirable to disinfect an atmosphere already so tainted, 
w T e have a ready means of diffusing a purifying agent 
through the atmosphere of an apartment, by resorting 
to the process of nebulization, so as to divide it in the 
most minute manner possible. In this manner, one or 
more instruments can be placed in action in different 
portions of the room, and kept up sufficiently to maintain 
a comparatively pure atmosphere. 



MEDICATED ATMOSPHERES. 375 

Then, also, in cases of disease where we wish to medi- 
cate the atmosphere with which the patient is sur- 
rounded, as with a terebinthinate or other impregnation, 
or simply to supply moisture, or to create an artificial 
sea-air, we can place one or more instruments in conve- 
nient localities and keep up such a medication as is re- 
quired, or renew it at proper intervals. So, too, in cases 
where patients are too feeble to make any effort at inha- 
lation, and where it is impossible or imprudent to call 
their attention to the process, an instrument may be set 
going in close proximity to them in such a manner that 
a portion of the air they inspire shall contain more or 
less of the nebala. 

Mention has already been made (p. 349) of the diseases 
to which certain classes of laborers are subjected from 
breathing the dust accumulating in the atmospheres in 
which they are working. Attempts have, been made at 
times to provide methods for preventing the inhalation 
of these dusts. Pliny mentions that workers in mines 
fastened bladders before their mouths, and that the Ro- 
man bakers placed cloths in front of their faces, when 
working in atmospheres loaded with these dusts. 

Of late years respirators with metallic meshes small 
enough to detain the deleterious particles of dust have 
been recommended to be worn over the mouth and nose 
during exposure to the injurious atmosphere. They are 
sometimes lightly packed with raw cotton, which detains 
fine particles which pass through the meshes, while it 
still permits the access of the air. Similar contrivances, 
impregnated with disinfectant solutions, are sometimes 
employed during exposure to poisonous atmospheres. 

It is often found that patients with phthisis, chronic 
bronchitis, or even only with delicate respiratory mucous 



376 



MEDICATED ATMOSPHERES. 



membrane, are unable to face the open air on inclement 
and windy clays. Sometimes patients are unable to 
withstand the changes of temperature, even on days 
that promise to be pleasant. Under such circumstances 
they are compelled to keep the house, or to muffle the 
mouth and nose with a handkerchief, veil, or something 
of that kind when they go out into the open air. The 



Fig. 29. 




Oro-nasal Eespirator. 

temperature of the air is modified by the warmth of the 
comforter, maintained by the air of expiration ; while at 
the same time, if too rich in oxygen, its pungency is 
moderated. Unmitigated sunlight is sometimes too irri- 
tating to sore eyes ; and in like manner unmitigated 
atmospheric air is sometimes too irritant to sore throats, 
bronchi, and lungs. In Great Britain a respirator of 
fine metallic netting covered with silk is ' much used, 
and if properly appreciated, would be much used in this 
country also. Some respirators are made merely to 



MEDICATED ATMOSPHERES. 377 

cover the mouth, so as to encourage nasal or normal 
respiration, and others (Fig. 29) to cover both mouth 
and nose. These appliances are unsightly, but their use 
often enables patients to take regular outdoor exercise, 
in carriage or on foot, instead of being compelled to 
remain indoors, almost constantly, for fear of catching 
cold. 

In 1848 Sales-Girons suggested the regularly supply- 
ing diseased lungs with a respiratory pabulum, suitable 
to their condition, on similar grounds to those defining 
suitable diet in diseases of the digestive organs; and 
this he called a " respiratory diet." Some resin, tar, or 
balsam, or whatever was intended to medicate the in- 
spired air, was placed within a respirator, to be worn in 
front of the patient's mouth, thus keeping him in the 
medicated atmosphere all day long, without confining 
him to one locality, and enabling him even to attend 
to his business without exposure to the unmitigated oxy- 
gen of the atmosphere, often prejudicial in many cases 
of diseases of the pulmonary organs. 

After several years' experience, Sales-Girons still 
maintains* that respiration is susceptible of diet as 
easily as digestion ; and for the purpose of supplying 
this diet he employs various substances, placed in the 
little apparatus, which the patient carries about him the 
greater part of the day, applied over the mouth and 
nostrils, to modify the atmosphere before it gains access 
to the respiratory tract. He contends that the respira- 
tory diet is in accordance with a theory of relations 
between the living organism and the atmosphere, or the 
theory of relations of the lungs with oxygen. 

* Gazette hebdomadaire, February 17th, 1860, p. 108. 



378 MEDICATED ATMOSPHERES. 

In the discussion which ensued at the Parisian Acad- 
emy of Medicine, upon Bouillaud's report upon the 
work of Sales-Girons,* M. Fontan put the query whether 
there was not in this production of Sales-Girons the 
germ of a grand discovery, that of a third state of oxy- 
gen, oxygen negatively electric, or sub-oxygen, in con- 
tradistinction to oxygen positively electric, ozone or sur- 
oxygen, and ordinary oxygen or neutral oxygen ? 

According to Prof. Dickson, f we would anticipate some 
soothing influence from the inspiration of air made to con- 
tain a less quantity of oxygen, which is generally regarded 
as a stimulant. He refers, however, to atmospheric 
mixtures with nitrogen and hydrogen, and with carbonic 
oxide or carbonic acid; and accounts in a similar way 
for the advantages said to have been derived by some 
consumptives from residing in stables with cattle, so 
much in vogue in England in the time of Darwin and 
Beddoes. 

This method of keeping up a peculiarly medicated 
atmosphere is much the same as Sales-Girons's respira- 
tory diet. 

Prof. Max LangenbeckJ devised an oral inhaler (see 
p. 29) for the same purpose, which he recommended for 
use in various diseases, with suitable medicaments. 

Still more recently, Dr. Oliver Somerville§ has sug- 
gested the same method for keeping patients in a carbo- 
lated atmosphere in phthisis, emphysema, and putrid 
bronchitis. 

In certain cases of phthisis and chronic bronchitis, 

* Gazette hebdomadaire, January 4th, 1861. 
f Elements of Medicine, Philada., 1855, p. 624. 
X Deutsche Klinik, 1861, No. 3. 
I The Lancet, July 8th, 1871, p. 45. 



MEDICATED ATMOSPHERES. 379 

where it is impracticable or injudicious to send the pa- 
tient to a warm and equable climate during the winter, 
much benefit will often accrue from imitating the cli- 
mate artificially at home. Two well-ventilated commu- 
nicating rooms may be suitably warmed, and kept con- 
stantly at a uniform temperature, and the atmosphere 
may be impregnated with resinous emanations from pine 
saplings in the sitting apartment, or may be otherwise 
medicated by some of the methods already described. 
In these rooms the patient should live. At certain hours 
of the day, when the outer atmosphere is warmest, say 
between twelve and two o'clock in the day, the patient 
can put on hat and over-clothing, as for a walk in the 
streets, and promenade the rooms for half an hour or 
longer, the windows being freely opened to secure an 
ample supply of fresh air during the exercise. In this 
manner the benefits of equable temperature and regular 
exercise in the open air can be secured without foregoing 
the comforts of home and the satisfaction of family in- 
tercourse. Some of my patients have pursued this plan 
with great advantage, and have apparently done better 
than they would have done in a milder climate, subjected 
to the discomforts and privations of a boarding-house or 
hotel life among strangers, and exposed to the baneful 
influence of constant or frequent contact with invalids. 



INDEX. 



Abdominal obstructions, 63 \ Aniseed, 150 

Abrahams, on oxygen in asphyxia, 68 Anstie, on arsenic in cardiac neu- 



Absorption, power of, by respiratory 

mucous membrane, 265 
Acetate of lead, 298, 337, 342, 368 
Acid, acetic, 152, 181 

carbolic, 13, 46, 115, 154, 308, 
313 

carbonic, 13, 83, 114, 200 

hydrocyanic, 114, 163, 333 

lactic, 322 

nitrous, 81 

pyroligneous, 154 

salicylic, 369 

sulphuric, 112, 322 

sulphurous, 112, 321 

tannic, 289 
Acidulated fumigations, 153 
iEsculapius, apparatus of, 336 
Air, artificial sea-, 97, 373 

cold, 36 

compressed, 37, 58, 200 

condensed, 37, 58 

fresh atmospheric, 33. 75 

rarefied, 37 

sea, 370 
Albuminuria, 78 
Almond oil, 269 

water (bitter), 329, 333 
Alum, 245, 284, 337, 363 
Aluminium, nitrate of, 304 
Ammonia, 113, 155 
Ammoniaeal exhalations, 372 
Ammoniacum, 134, 136 
Ammonium, 113 

bromide of, 309 

carbonate of, 113 

chloride, of, 13, 32, 115, 274, 368 
Amyl, nitrite of, 13, 131 
Analogy between compressed air and 

oxygen, 66 
Anemia, 39, 65, 66. 77, 80, 132, 280 
Angina, 38, 336 

pectoris, 120, 131 
Animal exhalations, 372 



ralgia, 171 
Antimony. 366 
Antiseptics, 166, 289, 315 
Aphonia. 38, 95, 108. 113, 124, 125, 
135, 147, 173, 264. 266, 268, 279, 
287, 294. 312, 327, 337 
AphthaB, 276, 363, 364, 368 
Apnoea, 58 
Apparatus for sprays, 184 

for tar vapors, 142 

of iEsculapius, 336 

Aretaeus, 336 

Arnold, 200 

Auphan, 184 

Beigel, 21 1 

Bergson, 196, 198 

Berkart, 43 

Biedert, 49 

Burow, 338 

Chambers, 342 

Clarke, 199 

Codman and Shurtleff, 208 

Cohen, 205, 210 

Corrigan, 31 

Darwin. 336 

Dobell, 44 

Fournie, 192 

Frankel, 52 

Gilewski, 340 

Hauke, 43 

Hippocrates, 13 

Jackson, 172 

Lewin, 32, 118, 190, 194, 204, 
339 

Mans, 203 

Mathieu, 188 

Matthews, 343 

Mudge, 20 

Pancoast 94 

Porter, 182 

Pretty, 182 

Pserhofer, 338 

Rauchfuss, 341 



o3 



382 



INDEX. 



Apparatus, of Read, 211 
Richardson, 203 
Sales-Girons, 184, 185, 190,377 
Sass, 201 
Schnitzler, 191 
Scudamore, 23 
Siegle, 206 
Storck, 56, 339 
Thomas, 342 
Treutler, 57 
Trousseau, 337 
Waldenburg, 45, 190 
Walford, 32 
Winterich, 201 
Appetite, stimulation of the, 15, 64 
Arabic, gum, 270, 311, 368 
Aretaeus, apparatus of, 336 
Armand, on opium, 157 
Arnica, 179 

Arnold, nebulizer of, 200 
Aromatic sulphurous acid, 322 
Aromatics, 14, 180 
Arsenic, 14, 170, 306 
Asphyxia, 59, 67, 68, 69 
Aspiratory chambers, 370 
Assafoetida, 334 
Asthenia, 77 

Asthma, 35, 36, 38, 39, 59, 63, 65, 
77, 84, 87, 112, 113, 114, 119, 
120, 121, 122, 131, 144, 152, 157, 
159, 161, 162, 163, 165, 170, 171. 
179, 266, 269, 271, 275, 306, 311, 
321, 330, 331, 332, 333, 334, 353 
Atelectasis, 59 

Atmospheres, impregnated or medi- 
cated, 13, 30, 87, 97, 101, 111, 
112, 116, 133, 137, 166, 177, 180, 
183. 197, 270, 370, 374, 378, 379 
Atmospheric air, 33 
Atropia, sulphate of, 332 
Auphan, on penetration of nebu- 
lized fluids, 229 
on sprays, 184 
Aural catarrh, 39 



Bader, on nitrite of amyl, 133 

Baillie, on tar, 141 

Balsams, 30, 122, 133, 307 

Barthez, on tannin by spray in 
croup, 291 

Bataille, on penetration of nebu- 
lized fluids, 229 

Baumgartner, on chloroform, 119 
on ether, 122 

Beddoes, on ether, 121 
on hydrogen, 82 



Beddoes. on nitrous oxide, 80 
on oxygen, 62 
on tar, 140 
Beigel, mouthpiece of, 22 
on diphtheria, 73 
on milk, 257 
on oxygen, 71 
on proportion of nebula inhaled, 

247 
steam nebulizer of, 211 
Belladonna, 159, 160, 164, 179, 309, 

331 
Bennet, on artificial balsamic at- 
mospheres, 133 
Benzine, 91, 154 
Benzoin, 134, 135, 264 
Bergson, nebulizer of, 196, 198, 258, 

280 
Berkart, apparatus of, for rarefied 

air, 43 
Bertin, on compressed air, 37 
Berton, on iodine, 97 
Besson, on ether in croup and diph- 
theria, 126 
Bicarbonate of sodium, 267, 273, 368 
Biedert, apparatus of, for compressed 

and rarefied air, 49 
Biniodide of mercury, 306 
Birch, on oxygen, 62 
Bismuth, 337, 364,369 
Boils, 78 
Borage, 159 
Borax, 136, 363, 364 
Bottger, on ozone, 79 
Bourrouillou, on method of inhal- 
ing sprays, 255 
Brand, on ammonia in coryza, 115 
Bretonneau, on chlorine in diphther- 
itis, 92 
on oxygen in croup, 71 
Briau, on penetration of nebulized 

fluids, 215 
Bromide of ammonium, 309 

of potassium, 309 
Bromine, 110, 114, 183, 309 
Bronchiectasia, 65, 149, 288, 301 
Bronchitis, 38, 46, 59, 78, 82, 87, 
94, 108, 112, 113, 117, 119, 122, 
123, 135, 136, 138, 141, 142, 145, 
148, 149, 152, 155, 157, 160, 161, 
170, 179, 180, 263, 264, 266, 269, 
271, 274, 275, 277, 278, 279, 286, 

295, 297, 300, 301, 306, 308, 309, 
314 

Bronchorrhoea, 108, 152, 288, 290, 

296, 297, 311, 315 
Brunton, on nitrite of amyl, 131 



INDEX, 



383 



Buchardt, on carbolic acid, 155 
Bumstead, vaporizer of, 29, 175 
Burnw, on nitrate of silver in pow- 
der, 338 
Burral, on nitrite of amyl, 133 
Buttles, inhaler of, 29 



Cade, oil of, 312 
Caillens, on oxygen, 62 
Calomel, 176, 337, 366 

vaporizers, 28, 29 
Camphor, 13, 14, 30, 107, 123, 151, 

164, 179, 311, 363, 368 
Camphorated tincture of opium, 

157, 324, 329 
Cancrum oris, 276 
Cannabis indicum, 157, 331 
Caraway, 150 

Carbolic acid, 13, 46, 109, 115, 154, 
308, 313 

water, 313 
Carbon, oxygen in poisoning from, 

69 
Carbonate of potassium, 274 

of sodium, 273, 368 
Carbonic acid, 13, 83, 114, 200, 371, 
372 

water, 268 
Carbuncles, 78 
Carburetted hydrogen, 87 
Carcinoma, 155, 298 
Carrick, inhaler of, 25 
Cases of aphonia, 96, 125 

asphyxia, 68 

asthma, 35, 306, 330, 353 

bromine poisoning, 183 

bronchitis, 123, 301 

bronchorrhoea, 108 

carbonaceous lungs, 351 

coal-miners' black lung, 354 

coryza, 105 

croup, 72, 128, 130, 168, 264, 
292, 310, 316, 318 

diphtheria, 73, 126, 127, 167, 
319, 320 

ganglionic enlargements, 65 

grinders' asthma, 353 

haemoptysis. 281, 283 

laryngitis, 2S5 

oedema of the larynx. 293, 325 

phthisis,- 75, 76, 101, 104, 239, 
244, 271, 327, 328. 331 

pulmonarv gangrene, 145, 277 

sore throa't, 299 

stenosis of the larynx, 288 

tonsillitis, 325 



Cases of whooping-cough, 81 
Cassia, 150 
Castor water, 334 

Catarrhs, 36, 97, 107, 116, 118, 122 
134, 135, 136, 142, 147, 149, 153, 
155, 165, 166, 178, 245, 266. 269, 
270, 274, 275, 284, 2S9, 295, 297, 
298, 301, 311, 327, 330, 363, 364, 
365, 368 
Cedar, 151 
Cephalalgia, 65 
Chambers, apparatus of, 341 
Chamomile, 151, 179 
Champouillon, on penetration of neb- 
ulized fluids, 217 
Chapman, on pyroligneous acid, 154 
on tobacco in spasmodic croup, 
162 
Chaptal, on oxygen, 62 
Charriere, inhaler of, 27 

spray producers of, 187 
Chartroulle, on iodine, 104 
Chaussier, on oxygen, 62 
Cbenopodium, 179 
Cheron, on oxygenated essences, 151 
Cherry, bark of wild, 330, 333 
Cherry-laurel water, 163, 333 
I Chevandier, on pitch, 137 
Chloral, 14 

Chlorate of potassium, 276, 386 
Chloride of ammonium, 13, 115, 136, 
274, 366, 368 
nascent vapors of, 32, 118 
of copper, 176 
of iron, 278, 333 
of mercury (corrosive), 304 
of sodium, 267 
of zinc, 298 
Chlorinated soda, 276 
Chlorine, 13, 30, 31, 32, 91, 276 

water, 276 
Chloroform. 13, 118, 131 
Chlorosis, 38, 63, 65, 77 
Cholera, 69, 70, 79, 120, 177, 265 
Cigarettes, arsenical. 171 
compound narcotic, 161 
ioduretted, 105 
mercurial, 173, 174 
of belladonna, 161 
of stramonium, 158 
and opium, 159 
and sage, 160 
Cinchona, 342 

Clapham, on nitrite of amyl in sea- 
sickness, 133 
Clarke, on ether, 122 

A., nebulizer of, 199 



384 



INDEX. 



Clemens, on chloride of copper, 176 
Cloves, 150 

Coal-miners' lung, 353, 358 
Codman and Shurtleff, steam nebu- 
lizer of. 209 
Cohen, spray producer of, 205, 210 
Cold air, 136 
Colic, 120 

Collins, on creasote water in scar- 
latina, 313 
on proportion of nebula inhaled 
in spray, 249 
Cologne water, 180, 264 
Coltsfoot, 134 
Combustion, fumes of substances 

volatile by, 14 
Compressed air, 37, 58 

analogy of oxygen and, 66 
and rarefied air, 37 

substitutes for, 61 
Condensed air, 37, 58 
Congestion of lungs, 38 
Conifers, resinous vapors of the, 136 
Conium, 98, 152, 161, 286, 309, 331 
Consumption, 34,36, 59, 142, 271,372 
Copaiba, 135 

oil of, 312 
Copland, on oil of pine, 149 
Copper, chloride of, 176 
oxide of, 362 
sulphate of, 297, 337 
Corrigan, apparatus of, 31, 95 
Corrosive sublimate, 174, 183, 304 
Coryza, 83, 84, 105, 106, 114, 115, 
120, 122, 153, 155, 156, 165, 173, 
263, 274, 275, 277, 278, 296, 297, 
313, 363, 364, 365, 366, 368, 369 
Cottereau, on chlorine, 92 
Coughs, 87, 119, 154, 158, 159, 160, 
161, 162, 163, 164, 165, 166, 189, 
268, 269, 270, 290, 309, 311, 323, 
324, 329, 330, 331, 332, 333, 334 
Counting, in asthma, 36 
Cow-houses, residence in or near, 371 
Coxe, his substitute for Corrigan's 
apparatus, 32 
on cool air, 36 
on copaiba, 135 
Creasote, 13, 151, 312 
Crichton, on naphtha, 154 
on tar, 140 
on turpentine, 144 
Croup, 71, 72, 73, 108, 110, 114, 120, 
126, 130, 144, 162, 165, 166, 175, 
179, 180, 181, 258, 264, 269, 274, 
279, 288, 290, 291, 310, 314, 315, 
318, 321, 322, 363, 366, 367 



Croup kettles, 182 

Cube, on compressed air, 46 

Cubeb. 150, 344 

oil of, 312 
Cuirass, pneumatic, of Hauke, 54 
Cummins, on sulphurous acid, 112 
Curran, on iodine in diphtheria, 10' 



Da Costa, on inhalation of oxide of 
copper by operatives, 362 
on lime water in diphtheria, 319 
on tannin spray in croup, 293 
Daguillon, on ammonium, 114 
Dannecy, on saturating narcotic 

plants with nitre, 159 
Darwin, apparatus of, 336 
Davy, on nitrous oxide, 80 
Delore, on penetration of nebulized 

fluids, 217 
Demarquay, on carbonic acid, 85 
on hydrogen, 83 
on oxygen, 63 

on penetration of nebulized 
fluids, 225 
Dewar, on sulphurous acid, 112, 321 
Diabetes, 77, 79 
Dickson, on grinders' asthma, etc., 

361 
Digitalis, 136, 332 
Dioscorides, arsenical cigars of, 171 
Diphtheria, 73, 77, 92, 96, 109, 110, 

112, 113, 126, 166, 175, 181, 258, 

264, 276, 278, 279, 288, 290, 291, 

313, 315, 319, 321, 322, 363, 366, 

367 
Disinfectants, 277, 278 
Dittel, on oil of pine, 150 
Dobell, residual-air-pump of, 44 
Domanski, on compressed air, 46 
Drake, on cold air, 36 
Ducroy, on oxygen, 67 
Duffield, on steam in poisoning by 

bromine, 183 
Dunton, on tar, 142 
Durand-Fardel, on penetration of 

nebulized fluids, 231 
Dust, diseases from, 349, 350, 359 
Dyspepsia, 63, 65, 66, 78 
Dysphagia, 324, 331 
Dysphonia, 113, 122, 268, 343 
Dyspnoea, 59, 121, 122, 142, 154, 158, 

164, 311, 332 



Earth-baths, 87, 371 
Eberle, on steam, 179 



INDEX. 



385 



Eberle, on tar, 141 
Ebert, on nitrate of silver in pow- 
der, 338 
Eckard, on oxygen, 65 
Eclectic inhaler, 24 
Effects of the inhalation of nebu- 
lized fluids, 250 
Elliotson, on chlorine, 93 

on creasote, 152 

on iodine, 99 
Emphysema, 38, 39, 59, 77, 94, 112, 
119, 147, 269. 271, 275, 297, 306. 
308, 309, 312, 315, 321, 332, 334 
Epilepsy, 78, 131 
Epistaxis, 107 
Erichsen, on asphyxia, 68 
Ergot, 296 
Erysipelas, 80, 277 
Essential oils, 150 
Ether, 13, 121, 179 

hydriodic, 103 
Ethereal oils, 14 
Ethmuller, on opium, 156 
Eucalyptus, 151 

Experiments as to penetration of 
nebulized fluids, 213 

as to penetration of powders. 
345 

of Auphan, 229 

of Bataille, 229 

of Beigel, 247 

of Briau, 215 

of Champouillon, 217 

of Cohen, 55, 86 

of Collins, 86, 249 

of Delore, 217 

of Demarquay, 63, 85, 225 

of Eckard, 65 

of Erichsen, 68 

of Fieber, 233 

of Fournie, 219, 346 

of Gerhardt, 244 . 

of Gratiolet, 229 

of Hauke, 89 

of Harwood, 17 

of Kollmann, 65 

of Lewin, 236 

of Mackenzie, 245 

of Moura-Bourouillou, 229 

of Pietra-Santa, 214 

of Rey, 218 

of Rosenthal, 347 

of Sales-Girons, 230 

of Schnitzler, 235 

of Smith, 64 

of Stork, 235 

of Tavernier, 228 



Experiments of Tobold, 235 

of Waldenburg, 244 

of Zenker, 356. 
Expiration, forced, of atmospheric 
air, 35 

into condensed air, 58, 60 

into rarefied air, 59, 60 



Face-pieces, 28 

Fennel-seed water, 329 

Fetid breath, etc., 109, 155, 269, 276, 

277, 27S, 311 
Fever, ephemeral, 112 
hay, 323 

intermittent, 66, 133, 323 
scarlet, 77, 112 
typhoid, 66, 80, 112 
Fieber, on cold water spray in 
hsemoptysis, 262 
on penetration of nebulized 

fluids, 233 
on tannin spray in croup, 293 
Fleming, on inhalation of oxide of 

copper by operatives, 362 
Forced inhalation of atmospheric 
air, 33 
inspiration of atmospheric air, 
61 
Fourcroy. on oxygen, 62, 63 

on the air in the vicinity of 
cow-houses, etc., 372 
Fournie, on penetration of nebulized 
fluids, 219 
on penetration of powders, 223, 

346 
spray-producer of, 192 
Fox, on ozone, 80 

Francis, on oxygen in scarlatina, 77 
Fiankel, apparatus of, for condensed 

and rarefied air, 52 
Frankincense, 134 
Fuchs, on chloride of ammonium, 

116 
Fumes, 13, 14, 134 
Fumigator of Mandl, 26 



Gadberry, on ether in bronchitis, 
123 
on ether in croup, 130 
Galbanum, 136 
Gannal, on chlorine, 91 
Gangrene of the lungs, 94, 145, 177, 
277, 278. 279. 288, 290, 295, 296, 
297, 306, 311, 314, 315, 365 
Gas, illuminating, 87, 115 



:ji 



386 



INDEX. 



Gases, 13, 14 

inhalation of various, in whoop- 
ing-cough, 89 

Geiger, on lime in croup, etc., 166 

Geiseler, on chloride of ammonium, 
116 

Gerhardt, on oil of pine. 149 

on penetration of nebulized 
fluids, 244 

Gibb, on penetration of nebulized 
fluids, 245 

Glandular enlargements, 65, 138 

Glycerin, 268, 275 

Goin, on carbonic acid, 84 

Gottwald, on bromine, 110 

Gout, 65, 78, 79, 112 

Grantham, on ammonium in whoop- 
ing-cough, 115 

Gratiolet, on penetration of nebu- 
lized fluids, 229 

Greenhow, on grinders' and miners' 
asthma, 353 

Grinders' asthma, 353 

Gum arabic, 270, 368 

Gymnastics, respiratory, 145 



Hager, on ammonia in eoryza, 115 
on carbolic acid in eoryza, 155 

Hand-ball nebulizers, 199, 202, 212 

Harwood, experiments of, 17 
on ammonium, 113 

Hauke, on inhalation of various 
gases in whooping-cough, 89 
pneumatic cuirass of, 54 
portable apparatus of, for com- 
pressed air, 43 

Hay-asthma, 162 
fever, 323 

Ha>matemesis, 60 

Haemoptysis, 36, 38, 59, 119, 160, 
250, 262, 278, 279, 280, 281, 283, 
288, 290, 295, 296, 297 

Haemorrhoids, 60 

Hearing, loss of, 126 

Heart, affections of, 267 

nervous, 157, 171, 306 
valvular diseases of, 39, 60, 78, 
274 

Hepatization, 38 

Hinton, on nitrite of amyl, 133 

Hippocrates, apparatus of, 13, 27 

Hoarseness, see Dysphonia. 

Hodson, on chlorine in diphtheria, 96 

Hoffman's anodyne, 122 

Home, on carbonic acid gas, 84 

Hooper, on oxygen, 67 



Hops, 150 

Horizontal nebulizers, 201, 203, 210 

Huette, on iodine, 103 

Hunter, on vapor of hot water, 179 

Hydrocyanic acid, 114, 163, 333 

Hydrogen, 82 

carburetted, S7 

sulphuretted, 83 
Hydrokomion of Bergson, 204 

of Siegle, 208 
Hydrostatic nebulizer, 200 
Hyoscyamus, 162, 295, 329, 366 
Hyperaesthesia, 331 
Hypochondria, 63 
Hysteria, 132, 136, 156 



Iced water, 250, 262 
Illuminating gas, 87, 115 
Influenza, 61 

Inhalation of airs, gases, vapors, 
and fumes, 13 

of dust, 350 

of nebulized fluids, 184, 216, 
257 

immediate effects of, 250 

manner of conducting, 251, 303 

of powders, 223, 336 
Inhalations, cold, 15, 30 

hot, 15, 17 

temperature of, 17, 253, 254 
Inhalatorium of Auphan, 184 

of Sales-G irons, 185 
Inhalers, of Buttles, 29 

of Carrick, 25 

of Charriere, 27 

of Corrigan, 31 

of Hooper, 67 

of Jackson, 172 

of Bangenbeck, 29 

of Banglebert, 28, 175 

of Mackenzie, 24 

of Mandl, 26 

of Merril, 30, 107 

of Mudge, 19 

of Muhlenberg, 27 

of Pomeroy, 30 

of Scudamore, 23 

of Snow, 27 

Wolfe-bottle, 21 
Inhaling, method of, 15, 251, 261 
Inspiration of compressed air, 58 

of rarefied air, 58, 60 
Insufflators, 340, 341 
Intermittent fever, 65, 133 
Iodide of potassium, 306, 308 
Iodine, 13, 14, 30, 96, 166, 307, 314 






INDEX. 



387 



Iodoform, 110 

Ipecacuanha, 333 

Ireland, on resinous vapors, 136 

Iron, 278 

chloride of, 278 

oxide of, 356 

sulphate of, 278, 295, 368 
Ischias, 136 



Jackson, on oxygen, 67 

Jenner, on vapor of water and acetic 

acid in diphtheria, 181 
Jumping-rope, exercise with, 34 
Juniper, 150 

Junod, on compressed air, 37 
Jurine, on oxygen, 62 
Jiitte, on oxygen in cholera, 70 



Kidneys, catarrh of the pelvis of 

the, 150 
Kollman, on oxygen, 65 



Luetic acid, 322 
Lactucarium, 157 
Laennec, on asthma, 36 
on chlorine, 93, 94 
on iodine, 97 
Lange, on compressed air, 41 
Langenbeck, inhaler of, 29 

on cool air, 36 
Langlebert, vaporizer of, 28, 175 
Laryngeal excrescences, 288, 290, 

304 
Laryngismus, 119 

Laryngitis, 106, 109, 134, 138, 148, 
150, 155, 157, 163. 170, 174, 179, 
245, 266, 267, 268, 275, 279, 285, 
286, 291, 297, 299, 308, 309. 312, 
314, 315, 321, 322, 333, 337, 365, 
366 
Lassegue, on chloride of ammoni- 
um. 116 
Lead, acetate of, 298, 337, 342, 368 
Lee, calomel vaporizer of, 176 
Lender, on ozone, 79 
Lente, on ether in croup, 128 
Leuthlen, on bromine, 110 
Lewin, apparatus of, 32, 118, 339 
on balsamic vapors, 135 
on chloride of ammonium, 118 
on inhalation of powders, 339, 

344 
on iodine, 105 
on oils of pine, 148 



Lewin on penetration of nebulized 
fluids, 236, 239 

spray-producers of, 190, 194, 
204. 257. 258 
Liebig, on compressed air, 41 
Lime, 166, 183, 315 

water, 269, 315 
Liniment, Stokes's, 145 

turpentine, 145 

St. John Long's, 145 
Little, on chlorine, 94 

on iodine, y9 
Livingston, on ether in croup, 128 
Lobelia, 333 
Louis, on chlorine, 93 
Luc, on iodine in coryza, 105 
Ludlow, on bismuth by insufflation, 
365 

on salicylic acid by insuffla- 
tion, 369 



Mack, compressed air-chambers of, 

41 
Mackenzie, inhaler of, 24 . 

on carbolic acid, 155 

on oil of pine, 150 

on penetration of nebulized 
fluids, 245 
Mackintosh, on tar, 141 

on vapor of hot water, 179 
Mandl, inhaler of, 26 

on creasote, 152 
Mans, spray-producer of, 203 
Marjoram. 150 
Mastic, 136 

Materia medica, articles of the, suit- 
able for inhalation in pow- 
der, 362 

in spray, 259 
Mathieu. spray-producer of, 188, 

192, 238, 280 
Matthews, apparatus of, 343 
Mead, on balsamic vapors, 134 
Measles, 80 

Medicated atmospheres, 370 
Melancholia, 156 
Menorrhagia, 60 
Mercury, 14, 172, 304, 337, 366 

inhalers for, 28, 29 
Merril, inhaler of, 30 

on camphor, 166 

on iodine, 106 
Method of inhaling powders, 340 

sprays, 251, 261 

vapors and fumes, 15 
Milk, 257 



388 



INDEX. 



Milliet, on compressed air, 38 
Millstone-makers' phthisis, 352 
Mineral waters, 184, 266, 270 
Mint, 151 

Mitchell, on nitrite of aniyl. 131 
Monell, on asthma, 35 
Morphia, 157, 295, 324, 329, 367 
Morton, on chlorine, 95 

on tar, 142 
Moura-Bourouillou, on method of 
inhaling sprays, 255 

on penetration of sprays, 229 
Mouthpieces, 19, 22, 47 
Mudge, inhaler of, 19 

on tar, 140 

on vapor of hot water, 178 
Murray, on chlorine, 92 

on iodine, 98 
Musk, 123 
Myrrh, 336, 368 



Naphtha, 153 

Narcosis, 67, 69, 133 

Narcotic cigarettes (Trousseau, Es- 

pic), 161 
Narcotics, 14, 122, 156, 324 
Narghile of the Persians, 136 
Nascent chloride of ammonium, 13, 

32, 118 
Nebulized fluids, inhalation of, 184 
Nebulizers, see Spray-producers. 
Nephogene, of Mathieu, 188 
Nervous affections, 66, 80, 119, 156, 

157, 171, 304 
Neuralgia, 66, 78, 131, 138, 157, 

171, 306, 368 
Nevins, on mercury, 173 
on nitrous acid, 82 
on stramonium, 159 
Niemeyer, on penetration of nebu- 
lized fluids, 245 
on turpentine, 147 
Nitrate of aluminium, 304 
of potassium, 163 
of silver, 245, 298, 337, 338, 342, 
365 
Nitre, 159 

paper, 163 
Noma, 276 

Nordmann, on ether in aphonia, 125 
Number, strength, and duration of 

inhalation of sprays, 257 
Nutgalls, 336 



Oakum, 142 



(Edema of larynx, 198. 290, 293, 
325, 363 

of lungs, 38 
Oertel, on vapor of water in diph- 
theria, 181 
Oil, almond, 269 

cod-liver. 269 

of cade, 312 

of copaiba, 312 

of cubeb, 312 

of turpentine, 311 

olive, 269 
Oils, volatile ethereal, 14 
Olive oil, 269 
Oliver, on carbolic acid, 154 

on oakum, 142 
Opium, 122, 123, 156, 179, 285, 286, 
309, 323, 327 

oxygen, in poisoning from, 69 

Snow's inhaler for, 27 
Oral inhalers, 29, 30, 378 
Oxide, nitrous, 13, 80 
Oxygen, 13, 61, 90, 200, 372, 378 

analogy between condensed air 
and, 66 

physiological effects of, 63 
Oxygenated essences, 151 
Ozanam, on bromine, 111 
Ozone, 79, 136, 138, 378 
Ozonic ether, 79 



Fancoast, on chlorine in aphonia, 95 
Paper, nitre or saltpetre, 164 

makers, exemption of, from 
phthisis,-91 
Paralysis, 66, 78, 80, 112 
Paregoric, 324, 329 
Pasch, on chloride of ammonium, 117 
Pathological proofs of penetration of 
nebulized fluids, 239, 244, 283 

of powders, 350, 361 
Paul, on oxygen in narcosis, 69 
Peacock, on millstone-makers- phthi- 
sis, 352. 360 
Pearson, on ether in phthisis, 121 

on hyoscyamus in phthisis, 162 
Pellitory, 159 

Penetration of nebulized fluids, ex- 
periments on, 213 

of powders, experiments on, 345 
Peppermint, 324, 334 
Percival, on carbonic acid, 83 
Permanganate of potassium, 278 
Persians, inhalations as pursued by 

the, 135, 174 
Peru, balsam of, 134 



INDEX. 



389 



Pharyngitis, 38, 106, 117, 174, 245, 
266, 267, 274, 275, 276, 279. 290, 
297, 298, 299, 308, 321, 366, 368 

Physick, on ether. 122 

Phosphoric poisoning, 148 

Phthisis, 38, 46, 60. 74, 76, 79, 80, 
82, 83, 84, 87, 91, 92, 93, 94, 97, 
98, 99, 100, 102, 104, 105, 110, 
112, 121, 134, 138, 141. 142, 145, 
147, 150, 151, 158, 161, 162, 163, 
171. 264, 267, 268, 269, 271, 275, 
277, 279, 280, 28S, 291, 298, 299, 
300, 306, 308, 311, 313, 314, 315, 
321, 324, 327, 328, 331, 333, 352, 
360, 371 

Physiological effects of oxygen, 64 

Pietra-Santa, on penetration of neb- 
ulized fluids, 214 

Pine forests, 136, 138, 370 
oils of, 148, 312 
mountain, 148 
Scotch, 148 

Piorry, on iodine, 100 

Pipe-inhalers, 30 

Pistachia, 136 

Pitch, 137 

Plants, exhalations from, in whoop- 
ing-cough, 90 

Pleurisy, 59, 60, 178 

Pneumatic chambers, 38, 39, 40 
cuirass, 54 

Pneumonia, 38, 39, 78, 119, 122, 
17S, 267, 274, 323 

Pocket steam nebulizer of Beigel, 
211 

Poggiale, on penetration of nebu- 
lized fluids, 230 

Poisoning by bromine, 183 
by phosphorus, 148 

Polak, on inhalations by the Per- 
sians, 135, 174 

Polyps, nasal, 364, 368 • 

Pomeroy, inhaler of, 30 

Porter, croup-kettle of, 182 

Potassium, arsenite of, 306 
bromide of, 309 
carbonate of, 274 
chlorate of, 276, 368 
iodide of, 306, 308 
permanganate of, 278 

Powders, inhalation of, 223. 366 

Pravaz, on compressed air, 37 

Pretty, croup-kettle of, 182 

Priestley, on oxygen, 61 

Pringle, on steam, 178 

Proportion of nebula inhaled in 
spray, 247 



Pserhofer, on nitrate of silver in 

powder, 338 
Ptyalism, 276 
Pyroligneous acid, 154 



hiinia, 136, 323 



Rachitis, 63 

Ramadge, on cool air, 36 

on forced inspirations, 34 
on turpentine, 145 
Rarefied air, 37, 40, 43, 54 
Raspail, on camphor, 165 
Rauchfuss, insufflator of, 340 
Read, steam nebulizer of. 211 
Red precipitate, 337, 366' 
Residual-air-pump, 44 
Resinous plants, 14 

vapors, 136, 139, 379 
Respirators, 142, 154, 375 
Respiratory diet, 376 
Retort inhaler, 27 
Rey, on penetration of nebulized 

fluids, 218 
Rhatany, 296 
| Rheumatism, 112, 137, 157 
Rhigini, on iodoform, 110 
Rhythmic respiration of compressed 

and rarefied air, 55 
Riadore, on nitrous oxide, 80 
Richardson, on oxygen in asphyxia, 
67 
spray-producer of, 203 
Ringer, on iodine in coryza, 106 

and Murrel, on ipecacuanha in 
winter cough, etc., 334 
Rodgers, on oxygen in cholera, 69 
Rohn, on nitrate of silver in whoop- 
ing-cough, 302 
Rose, on condensed and rarefied air, 

49 
Rosenthal, on penetration of pow- 
ders, 347 
Rush, on steam, 178 
on tar, 140 



Sage, 151, 160, 179 
Sahndall, on compressed air, 38 
Sales-Girons, apparatus of, 186 
inhalatorium of, 185 
on indications for inhalations of 

sprays, 260 
on penetration of nebulized 
fluids, 230 



390 



INDEX. 



Sales-Grirons on respiratory diet, 376 

on sprays, 184 
Salicine, 136 
Salicylic acid, 369 
Saline waters, 267 
Salt, 270, 275, 307, 368 
Salter, on chloroform in asthma, 120 

on stramonium in asthma, 158, 
160 

on tobacco in asthma, 162 
Saltpetre, 163 

Sanderson, on compressed air, 40 
Sass, horizontal nebulizer of, 201 
Scarlatina, 77, 112, 179, 278, 288, 

313 
Schnitzler, on penetration of nebu- 
lized fluids, 235 

spray-producer of, 191 
Schiitz, on bromine, 110 
Scorbutus, 78 

Scrofula, 63, 78, 301, 304, 308 
Scudamore, inhaler of. 23 

on chlorine, 93 

on conium, 161 

on ether, 121 

on iodine, 98 
Sea-air, 370 

artificial, 97, 270, 373 

sickness, 133 

weed, in phthisis, 97 
Semeleder, on penetration of nebu- 
lized fluids, 245 
Senile catarrh, 107 
Shumman, on nitrous oxide, 80 
Siegle, rules of, for inhaling sprays, 
253, 255, 256 

steam nebulizer of, 206 
Silver, nitrate of, 298, 337, 338, 365 
Simon, on iodine, 104 
Simpson, on carbonic acid, 87 
Sims, on stramonium, 158 
Skoda, on ether, 122 

on turpentine, 145 

on vapor of hot water, 179 
Smee, on ammonium, 113 
Smith, on oxygen, 64, 74 
Snow, on camphor, 165 

on conium, 161 

on iodine, 27 

on opium. 156 

on turpentine, 145 
Snuff, 363, 368 

Sodium, bicarbonate of, 269, 273, 
368 

carbonate of, 273, 368 

chloride of, 267. See Salt. 
Solon, on balsamic vapors, 134 



Solon, on stramonium, 158 

Sore throat, 263, 268, 276, 288, 290 

304, 308, 313, 325, 363, 367 
Spasm, 118, 131, 132, 136, 156, 164, 

165, 166, 189, 266, 290, 309, 324, 
330, 331, 332 
Speech, loss of, 126 
Spengler, on carbonic acid, 84 
Spray, inhalation of, 184 

producers, 186, 188, 190, 191, 
192, 194, 196, 198, 199, 200, 
201, 203, 205, 206, 209, 210, 
211, 212 
Squill, 121, 179 

Stables, residence in or near, 371 
Steam, 170, 178, 181, 183, 191, 206 

nebulizers, 212 
Stehberger, on glycerin in croup, 

269 
Stenosis, 59, 288 
Stokes, on chlorine, 94 
on conium, 161 
on iodine, 99 
on turpentine, 144 
Stony concretions in the lungs, 358 
Stork, apparatus of, for compressed 
and rarefied air, 56 
apparatus of, for insufflation of 

powders, 339 
on penetration of nebulized 
fluids, 235 
Stramonium, 158, 164, 332 
Sty rax, 134 

Substitutes for compressed and rare- 
fied air, 61 
Sugar, 368 

of milk, 337 

residence in or near manufac- 
tories of, 372 
Sulphate of copper, 297, 337 
of iron, 278, 368 
of zinc, 296, 337, 369 
Sulphur, 14, 111, 367 
Sulphuretted hydrogen, 83 
Sulphuric acid, 112. 322 
Sulphurous acid, 112, 266, 321 

waters, 259, 266 
Summary on inhalation of nebulized 

fluids, 334 
Surgical affections, oxygen in, 66 
Syncope, 133 
Syphilis, 78, 138, 155, 174, 268, 304, 

305, 308, 309, 322, 337, 366 
Syringe for sprays, 188 



Tabarie, on condensed air, 37, 38 



INDEX. 



391 



Tanneries, vapors from, 372 
Tannin, 245, 268, 270, 289, 363, 

368 
Tar, 14, 30, 139, 315 

water, 288, 315,330 
Tavernier, on penetration of nebu- 
lized fluids, 288 
Temperature, best, for inhalations, 
17 
of sprays, 253, 254 
uniformity of, during inhala- 
tion, 14 
Tetanus, 131 

Thomas, on nitrate of silver in pow- 
der, 342 
on nitrous acid, 81 
Thompson, on chlorine, 93 
Thorn apple, 158 
Tobacco, 158, 160, 162 
Tobold, on penetration of nebulized 

fluids, 235 
Tolu, 134 
Tonsillitis, 61, 113, 142, 262, 266, 

274, 276, 278, 297, 325 
Toulmouche, on chlorine, 93 
Tracheitis, 38, 268 
Tracheotomy. 183 

Traube, on penetration of dust, etc., 
351 
on turpentine, 148 
Treutler, apparatus of, for com- 
pressed and rarefied air, 57 
Trousseau, and Pidoux, on balsamic 
vapors, 134 
contrivance of, for inhalation of 

powders, 337 
mercurial cigarettes of. 173 
narcotic cigarettes of, 161 
on ammonium, 114 
on arsenic, 171 

on inhalation of powders, 337 
on penetration of nebulized 

fluids, 228, 232 
on stramonium, 158 
on tannin spray in oedema of 
the larynx, 293 
Tuberculosis, 81, 109, 197, 239, 271, 

301, 323, 328, 332 
Tubes, for camphor, 165 
for powders, 339 
of Bergson. for nebulization, 

197 
of Wintericb, for nebulization, 
201 . 
Turpentine, 30, 46, 131, 134, 138, 

144, 311 
Tweedie, on balsamic vapors, 134 



Tweedie, on steam, etc., 179 
Typhoid fever, 65, 66 



Ulcers, 78 



Vapors, 13, 14 

Vaporizers, 27, 28, 175, 176 

Varec, in phthisis, 97 

Vinegar, 141, 179, 181, 264 

Virchow, on carbonaceous lungs, 
358 

Viveuot, on compressed air, 39 

Vogel, on camphor, 166 

Vogelsang, on bromine in whooping- 
cough, 111 



"Waldenburg, apparatus of, for con- 
densed and rarefied air, 45 
inhaler of, 27 

on ammonium in coryza, 115 
on camphor, 166 
on lime-water in diphtheria, 319 
on penetration of nebulized 

fluids, 244 
spray-producer of, 190 
Walford, apparatus of, 32 
Wanner, on vapor of water in croup, 

181 
Water, 262 

alkaline, 267 
carbonic acid, 268 
cold, 262 
hot, 177 
iced, 250, 262 
mineral, 184, 266 
saline, 267 
sulphurous, 259. 266 
vapor of, in cholera, 70 

with spray, in cholera. 191 
warm, 262, 293, 329, 330 
Waterman, on aromatic alcoholic 

inhalations, 180 
Wedemann, on penetration of nebu- 
lized fluids, 245 
Whooping-cough, 38, 39, 81, 87, 89, 
90, 91, 111, 112, 115, 119, 122, 
131, 132, 141, 144, 147, 154, 155, 
156, 157, 160, 162, 163, 268, 269, 
274, 279. 287, 295, 302, 309, 323, 
324, 330 
Wild, on whooping-cough, 131 
Wild cherry, 330, 333 
Winterich, horizontal nebulizer of, 
201 



392 



INDEX. 



Wittmeyer, on nebulized water in 

cholera, 265 
on oxygen and vapor of water in 

cholera, 70 
Wolfe-bottle inhaler, 21 
Wood, on tar, 142 
Wool, undressed, 139 

Xanthoxylum, 179 



Zdekauer, on pathological proofs 
of penetration of nebulized fluids, 
244 
Zenker, on iron in the lungs of oper- 
atives. 356 
Zinc, chloride of, 298 
oxide of, 367, 369 
sulphate of, 296, 327, 369 



HANDBOOKS AND MANUALS 

FOR THE 

BUSY PKACTITIONER AND STUDENT. 

PUBLISHED BY 

LINDSAY & BLAKISTON, PHILADELPHIA. 



This Series of Works has been prepared by Authors of established 
reputation in the specialties upon which they have written. They 
are compact in size ; brief and explicit in their contents, but contain- 
ing all that is essential under ordinary circumstances, and are ad- 
mirably adapted to the wants of the Busy Practitioner and Student 
who have neither time nor leisure to consult or read the more elab- 
orate and expensive treatises. 

Clay's Complete Handbook of Obstetric Surgery. With nu- 
merous Illustrations. Price, $2.25. 

Swain's Manual of Surgical Emergencies. With numerous Il- 
lustrations. Price, $2.00. 

Athill's Clinical Lectures on Diseases Peculiar to Women. 

With Illustrations. Price, $2.25. 

Dillnberger's Handy-Book of Women's and Children's Dis- 
eases. Price, $1.75. 

Rutherford's Outlines of Practical Histology. With Illustra- 
tions. Price, $1.25. 

Wagstafle's Students' Guide to Human Osteology. With 23 
Lithographic Illustrations, and 66 Wood Engravings. Price, 
$3.50. 

Cohen on Inhalations: its Therapeutics and Practice. Second Edi- 
tion ; much enlarged. With New Illustrations. Price, $2.75. 

Lawson's Diseases and Injuries of the Eye: their Medical and 

Surgical Treatment. With Illustrations. Price, $2.50. 

Harley on the Urine and its Derangements. With Engravings. 

Price, $2.75. 






Tyson's Practical Guide to the Examination of Urine. Illus- 
trated. Price, $1.50. 

Tibbitt's Handbook of Medical Electricity. With 65 Illustra- 
tions. Price, $2.00. 

Dalby on the Diseases and Injuries of the Ear. With Illus- 
trations. Price, $1.50. 

Heath's Manual of Minor Surgery and Bandaging. With nu- 
merous Illustrations. Price, $2.00. 

Wilson's Handbook of Hygiene and Sanitary Science. With 
Engravings.' Price, $2.50. 

Allingham on Fistula, Haemorrhoids, and other Diseases of 
the Rectum. Price, $2.00. 

Lewin on the Treatment of Syphilis by Subcutaneous Subli- 
mate Injections. With Plates. Price, $2.25. 

Bradley's Manual of Comparative Anatomy and Physiology. 

With Illustrations. Price, $2.50. 

Bloxam's Manual of Laboratory Teaching ; or, Progressive Ex- 
ercises in Practical Chemistry. Illustrated. Price, $2.00. 

Black's Functional Diseases of the Renal, Urinary, and Re- 
productive Organs. Price, $2.50. 

Coles's Manual of Dental Mechanics. 140 Illustrations. Price, 

$2.50. 

Ellis's Manual of the Diseases of Children. With Formulary. 

Price, $2.75. 

Hardwick and Dawson's Manual of Photographic Chemistry. 

With Engravings. Price, $2.00. 

Mayne's Medical Vocabulary. An Explanation of Terms, Phrases, 
etc., used in Medicine. Fourth Edition. Price, $3.00. 

Frankland's How to Teach Chemistry. Price, $1.25. 

Thorowgood's Students' Guide to Materia Medica. With Il- 
lustrations. Price, $2.50. 

Sew ell's Students' Guide to Dental Anatomy and Surgery. 

Preparing. 

"Woodman and Tidy's Handbook of Forensic Medicine and 
Toxicology. Preparing. 

Roberts's Students' Guide to Practical Midwifery. With En- 
gravings Now Ready. Price, $2.25. 



